Provider Demographics
NPI:1003279464
Name:SAMELSON, MONICA KRISTIN (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:KRISTIN
Last Name:SAMELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 E ALDER ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5622
Mailing Address - Country:US
Mailing Address - Phone:206-558-5495
Mailing Address - Fax:
Practice Address - Street 1:1613 E ALDER ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5622
Practice Address - Country:US
Practice Address - Phone:206-558-5495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-03
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD609783812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry