Provider Demographics
NPI:1639391345
Name:EBBESON, ERIKA L
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:L
Last Name:EBBESON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ERIKA
Other - Middle Name:L
Other - Last Name:EBBESON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP, RC
Mailing Address - Street 1:216 168TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-4522
Mailing Address - Country:US
Mailing Address - Phone:425-417-5487
Mailing Address - Fax:425-827-9090
Practice Address - Street 1:1313 MARKET ST
Practice Address - Street 2:SUITE 3000
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5456
Practice Address - Country:US
Practice Address - Phone:425-417-5487
Practice Address - Fax:425-827-9090
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007999174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist