Provider Demographics
NPI:1194756288
Name:REDMON, MARC DAVID (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:DAVID
Last Name:REDMON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1429 AVENUE D # 423
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1742
Mailing Address - Country:US
Mailing Address - Phone:206-380-6142
Mailing Address - Fax:
Practice Address - Street 1:316 MAPLE AVE # B
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2526
Practice Address - Country:US
Practice Address - Phone:206-380-6142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7139835Medicaid
WAPY00003507OtherPROFESSIONAL LICENSE - CLINICAL PSYCHOLOGIST