Vanessa G Dzivakwe, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY 60666097 Issued in WA

Practice address

509 Olive Way Ste 204
Seattle, WA 98101-1726

Phone

(206) 329-5255

Fax

(206) 726-1878

NPI assigned

Aug 16, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2017 through Jan 1, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1013340793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 OLIVE WAY STE 204",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981011726",
            "telephone_number": "206-329-5255",
            "fax_number": "206-726-1878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 OLIVE WAY STE 204",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981011726",
            "telephone_number": "206-329-5255",
            "fax_number": "206-726-1878"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "818 12th Ave",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981224410",
            "country_code": "US",
            "telephone_number": "206-329-5255 x302",
            "fax_number": "206-726-1878",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DZIVAKWE",
        "first_name": "VANESSA",
        "middle_name": "G",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-16",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY 60666097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaun David Dyreng, RN
• Sarah Scott Dyrhaug
• Jorg Dziersk
• Caitlin Dzikon, PHD
• Kristan Dziurzynski
• Dzuy Nguyen DDS MSD PLLC
• Mara E Tynan, PHD
• E1Spine PLLC
• E2 Medical Group PLLC
• Anne Marie Eacker

• Psychologist in Seattle, WA
• Providers in Seattle, WA by specialty
• Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.