Provider Demographics
NPI:1326461401
Name:RETZLAFF, LYNDEE ELSIE
Entity Type:Individual
Prefix:MRS
First Name:LYNDEE
Middle Name:ELSIE
Last Name:RETZLAFF
Suffix:
Gender:F
Credentials:
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 969
Mailing Address - Street 2:ATTN LYNDEE RETZLAFF
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-0969
Mailing Address - Country:US
Mailing Address - Phone:425-831-5425
Mailing Address - Fax:
Practice Address - Street 1:9575 ETHAN WADE WAY SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9577
Practice Address - Country:US
Practice Address - Phone:425-831-5425
Practice Address - Fax:425-831-5428
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60390127101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2178783Medicaid