Provider Demographics
NPI:1932292133
Name:BRISTOW, MONICA L (PHD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17530 NE UNION HILL RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052
Mailing Address - Country:US
Mailing Address - Phone:425-883-2623
Mailing Address - Fax:425-883-6241
Practice Address - Street 1:17530 NE UNION HILL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-883-2623
Practice Address - Fax:425-883-6241
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001416103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA108305Medicare ID - Type Unspecified