Provider Demographics
NPI:1154417954
Name:POLLOCK, DIANA LYNN (MA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15233 SE 176TH PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9053
Mailing Address - Country:US
Mailing Address - Phone:206-601-5775
Mailing Address - Fax:
Practice Address - Street 1:15233 SE 176TH PL
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-9053
Practice Address - Country:US
Practice Address - Phone:206-601-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00000891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist