Provider Demographics
NPI:1134674930
Name:MADSEN-HUMENIUK, ASHA AMBER LYNN (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:ASHA
Middle Name:AMBER LYNN
Last Name:MADSEN-HUMENIUK
Suffix:
Gender:F
Credentials:PSYD, LP
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 70113
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98127-0111
Mailing Address - Country:US
Mailing Address - Phone:206-280-0388
Mailing Address - Fax:
Practice Address - Street 1:6319 22ND AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-2417
Practice Address - Country:US
Practice Address - Phone:206-280-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61058287103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling