Basic Information
| Provider Information | |||||||||
| NPI: | 1063939759 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMILTON | ||||||||
| FirstName: | GRACE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5127 | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982065127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253395453 | ||||||||
| FaxNumber: | 4252258020 | ||||||||
| Practice Location | |||||||||
| Address1: | 15418 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MILL CREEK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980129030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253395453 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2017 | ||||||||
| LastUpdateDate: | 10/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | PSY31627 | CA | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103T00000X | PY61073285 | WA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.