Provider Demographics
NPI:1609812536
Name:EDENHOLM, MONICA ELENA (LMFTA, PA-C)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:ELENA
Last Name:EDENHOLM
Suffix:
Gender:F
Credentials:LMFTA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 NE 143RD ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3523
Mailing Address - Country:US
Mailing Address - Phone:206-915-3253
Mailing Address - Fax:
Practice Address - Street 1:2704 NE 143RD ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-3523
Practice Address - Country:US
Practice Address - Phone:206-915-3253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004541363A00000X, 363AM0700X
WA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1014354Medicaid
G8947420Medicare PIN