Provider Demographics
NPI:1982033940
Name:WASSON, ELIZABETH J (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:J
Last Name:WASSON
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 1:4033 E MADISON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3104
Mailing Address - Country:US
Mailing Address - Phone:206-568-6492
Mailing Address - Fax:
Practice Address - Street 1:4033 E MADISON ST STE 203
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3104
Practice Address - Country:US
Practice Address - Phone:206-568-6492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-10
Last Update Date:2013-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2219103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent