Provider Demographics
NPI:1932579364
Name:SIOBHAN BUDWEY PHD, PLLC
Entity Type:Organization
Organization Name:SIOBHAN BUDWEY PHD, PLLC
Other - Org Name:SIOBHAN BUDWEY, PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SIOBHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDWEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-972-5127
Mailing Address - Street 1:324 W BAY DR NW
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4926
Mailing Address - Country:US
Mailing Address - Phone:360-972-5127
Mailing Address - Fax:360-359-7708
Practice Address - Street 1:324 W BAY DR NW
Practice Address - Street 2:SUITE 220
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4926
Practice Address - Country:US
Practice Address - Phone:360-972-5127
Practice Address - Fax:360-359-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60302520103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038219Medicaid
WA2038219Medicaid