Provider Demographics
NPI:1912588088
Name:NEUROPSYCHOLOGY AND REHABILITATION SERVICES OF WASHINGTON
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGY AND REHABILITATION SERVICES OF WASHINGTON
Other - Org Name:KELLY CORNETT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:AKIKO
Authorized Official - Last Name:CORNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:425-209-0828
Mailing Address - Street 1:2313 242ND PL SW
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-9349
Mailing Address - Country:US
Mailing Address - Phone:425-209-0828
Mailing Address - Fax:
Practice Address - Street 1:1455 NW LEARY WAY STE 400A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5138
Practice Address - Country:US
Practice Address - Phone:425-209-0828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty