Gary Allen Vandalfsen, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY00001869 Issued in WA

Practice address

11808 Northup Way
Suite W-150
Bellevue, WA 98005-1936

Phone

(425) 822-0242

Fax

(425) 889-1249

NPI assigned

Feb 27, 2007

Sex

Male

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Summit Consulting Group, Inc.

  • Clinical Psychologist
  • Mill Creek, WA
  • NPI 1568525251
  NPD (past)

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619004819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11808 NORTHUP WAY",
            "address_2": "SUITE W-150",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980051936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11808 NORTHUP WAY",
            "address_2": "SUITE W-150",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980051936",
            "telephone_number": "425-822-0242",
            "fax_number": "425-889-1249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDALFSEN",
        "first_name": "GARY",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY00001869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Van Zyl, M.D.
• Shalyna Van
• Grace Anne Vanallen, PTA
• Rebecca June Vanbebber
• Eldon Byron Vance, MSW
• Matthew Vande Vrede, CB61419139
• David W Vandegrift
• Russell Albert Vandenbelt, M.D.
• Kristine Ann Vanderhart
• Vanderhoef Kerr and Iannielli PLLC

• Clinical Psychologist in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.