Provider Demographics
NPI:1992954606
Name:BUDWEY, SIOBHAN CHERISSE (PHD)
Entity type:Individual
Prefix:MRS
First Name:SIOBHAN
Middle Name:CHERISSE
Last Name:BUDWEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 W BAY DR NW STE 220
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4926
Mailing Address - Country:US
Mailing Address - Phone:360-972-5127
Mailing Address - Fax:
Practice Address - Street 1:324 W BAY DR NW STE 220
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4926
Practice Address - Country:US
Practice Address - Phone:360-972-5127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPSY60302520103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038219Medicaid
WAG8916183Medicare PIN