Provider Demographics
NPI:1225189327
Name:EWALD, LINDA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:S
Last Name:EWALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10940 NE 33RD PL
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1432
Mailing Address - Country:US
Mailing Address - Phone:425-827-3030
Mailing Address - Fax:425-822-2960
Practice Address - Street 1:10940 NE 33RD PL
Practice Address - Street 2:SUITE 107
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1432
Practice Address - Country:US
Practice Address - Phone:425-827-3030
Practice Address - Fax:425-822-2960
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical