Provider Demographics
NPI:1508046640
Name:HENDRICKSON, RAY NONE (PHD)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:NONE
Last Name:HENDRICKSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13716 LAKE CITY WAY NE APT 309
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-2601
Mailing Address - Country:US
Mailing Address - Phone:360-298-4523
Mailing Address - Fax:
Practice Address - Street 1:13716 LAKE CITY WAY NE APT 309
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-2601
Practice Address - Country:US
Practice Address - Phone:360-378-4004
Practice Address - Fax:360-378-2787
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2974103TB0200X, 103TC0700X, 103TF0000X, 103TM1800X, 103TF0200X
WAPY00002974103TC0700X, 103T00000X
PY00002974103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist