Provider Demographics
NPI:1699755561
Name:HENDRICKSON, MARY JOSEPHINE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOSEPHINE
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16040 CHRISTENSEN RD
Mailing Address - Street 2:STE 212
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188
Mailing Address - Country:US
Mailing Address - Phone:206-431-5336
Mailing Address - Fax:206-431-5430
Practice Address - Street 1:5825 221ST PLACE SE
Practice Address - Street 2:STE 201
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:206-431-5336
Practice Address - Fax:425-391-7014
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPY2719103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist