Provider Demographics
NPI:1891857520
Name:RISDON, MARY A (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:A
Last Name:RISDON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 RICHARDS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3982
Mailing Address - Country:US
Mailing Address - Phone:425-454-7541
Mailing Address - Fax:
Practice Address - Street 1:1808 RICHARDS RD STE 105
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3982
Practice Address - Country:US
Practice Address - Phone:425-454-7541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003582103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical