Provider Demographics
NPI:1689826679
Name:QUEVEDO, YOLANDA GRADO (PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:GRADO
Last Name:QUEVEDO
Suffix:
Gender:F
Credentials:PHD, LMHC
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 683
Mailing Address - Street 2:
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-0683
Mailing Address - Country:US
Mailing Address - Phone:360-466-7265
Mailing Address - Fax:360-466-5528
Practice Address - Street 1:17400 RESERVATION RD
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-8801
Practice Address - Country:US
Practice Address - Phone:360-466-7265
Practice Address - Fax:360-466-5528
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 00006081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1992791Medicaid