Provider Demographics
NPI:1114306073
Name:TEDROW, LORRAINE (LMHC)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:TEDROW
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55461
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-0461
Mailing Address - Country:US
Mailing Address - Phone:206-321-5375
Mailing Address - Fax:
Practice Address - Street 1:10015 LAKE CITY WAY NE
Practice Address - Street 2:# 317-318
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7770
Practice Address - Country:US
Practice Address - Phone:206-321-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60434677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health