Provider Demographics
NPI:1225817877
Name:EDSTROM, LEIHUA (PHD, ABSNP)
Entity Type:Individual
Prefix:DR
First Name:LEIHUA
Middle Name:
Last Name:EDSTROM
Suffix:
Gender:F
Credentials:PHD, ABSNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 156TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-8712
Mailing Address - Country:US
Mailing Address - Phone:206-372-6038
Mailing Address - Fax:
Practice Address - Street 1:15129 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-9036
Practice Address - Country:US
Practice Address - Phone:206-372-6038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002829103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent