Provider Demographics
NPI:1780735365
Name:MELMAN, KATHY NEWPORT (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:NEWPORT
Last Name:MELMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:SUE
Other - Last Name:NEWPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16040 CHRISTENSEN ROAD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2966
Mailing Address - Country:US
Mailing Address - Phone:206-244-9959
Mailing Address - Fax:206-241-7346
Practice Address - Street 1:16040 CHRISTENSEN ROAD
Practice Address - Street 2:SUITE 217
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98188-2966
Practice Address - Country:US
Practice Address - Phone:206-244-9959
Practice Address - Fax:206-241-7346
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1080103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00010835Medicare ID - Type UnspecifiedPROVIDER NUMBER