Provider Demographics
NPI:1003658592
Name:TARTER, ELAINE FRIEDERIKE (BS)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:FRIEDERIKE
Last Name:TARTER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10347 MIDVALE AVE N APT 5
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9449
Mailing Address - Country:US
Mailing Address - Phone:425-287-2009
Mailing Address - Fax:
Practice Address - Street 1:1380 112TH AVE NE STE 206
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3759
Practice Address - Country:US
Practice Address - Phone:425-287-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61397989106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician