Provider Demographics
NPI:1568501815
Name:TETZLOFF, MONIQUE LYNN (MS, MHP, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:LYNN
Last Name:TETZLOFF
Suffix:
Gender:F
Credentials:MS, MHP, LMFT
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:LYNN
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 12TH AVE S STE 901
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2712
Mailing Address - Country:US
Mailing Address - Phone:206-548-3058
Mailing Address - Fax:206-262-0859
Practice Address - Street 1:6760 34TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-4208
Practice Address - Country:US
Practice Address - Phone:206-548-3164
Practice Address - Fax:206-973-8786
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00043538101YP2500X
WALF00002688106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional