Provider Demographics
NPI:1700015229
Name:TRUJILLLO, MALINDA ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MALINDA
Middle Name:ELIZABETH
Last Name:TRUJILLLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:ELIZABETH
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1499 SE TECH CENTER PL STE 190
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5529
Mailing Address - Country:US
Mailing Address - Phone:970-310-7140
Mailing Address - Fax:
Practice Address - Street 1:1499 SE TECH CENTER PL STE 190
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5529
Practice Address - Country:US
Practice Address - Phone:970-310-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TC1900X
WA60482914103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist