Unknown Individual – Clinical Psychologist, NPI 1417365982

Unknown Individual is a healthcare provider. based in Vancouver, Washington. specializing in Clinical Psychologist. They hold a License No. PY60049899 (WA). The NPI Number for Unknown Individual is 1417365982

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1417365982
Phone
(360) 253-4912
Address
9340 NE 76TH ST
Deactivation Date
29 January 2026

Doctor Profile

Medical School Name
UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE
Secondary Phone
3607549792
Graduation Year
1983 (43 years ago)
PAC ID
1355664251
Group Practice PAC ID
7719032226
Professional Enrollment ID
I20150102001517
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 9340 NE 76TH ST

    VANCOUVER, WA 986623721

    Phone: (360) 253-4912

    Fax: (360) 253-5170

    Type: Location

  • 1658 DISCOVERY ST

    WALLA WALLA, WA 993625010

    Phone: (509) 240-7150

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 98662)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7719032226View full group profile
NameSpecialtyState
Clinical PsychologistWA
Clinical PsychologistWA
Clinical PsychologistWA
Clinical PsychologistHI
-WA
Clinical PsychologistFL
Mental Health CounselorWA
Clinical PsychologistWA
-AZ
Clinical PsychologistWA

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1417365982.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Clinical Psychologist. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Vancouver, Washington because that is what the record indicates for Unknown Individual.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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