Provider Demographics
NPI:1700905825
Name:MUSCATEL, KENNETH MARK (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MARK
Last Name:MUSCATEL
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:1001 BROADWAY
Mailing Address - Street 2:SUITE 318
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4397
Mailing Address - Country:US
Mailing Address - Phone:206-324-4443
Mailing Address - Fax:203-324-4443
Practice Address - Street 1:1001 BROADWAY
Practice Address - Street 2:SUITE 318
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4397
Practice Address - Country:US
Practice Address - Phone:206-324-4443
Practice Address - Fax:206-324-4443
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA775103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist