Provider Demographics
NPI:1811046808
Name:KEAN, SHARON INEZ (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:INEZ
Last Name:KEAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:KEAN
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:7012 50TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6128
Mailing Address - Country:US
Mailing Address - Phone:206-527-0245
Mailing Address - Fax:
Practice Address - Street 1:4915 25TH AVE NE
Practice Address - Street 2:SUITE 202-WEST
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5667
Practice Address - Country:US
Practice Address - Phone:206-285-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA430103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA430OtherPSYCHOLOGY LICENSE