Provider Demographics
NPI:1104134246
Name:RASTALL, EMILY JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:JANE
Last Name:RASTALL
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 1:8349 JONES AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3503
Mailing Address - Country:US
Mailing Address - Phone:360-904-8111
Mailing Address - Fax:
Practice Address - Street 1:4909 25TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4107
Practice Address - Country:US
Practice Address - Phone:206-987-8080
Practice Address - Fax:206-987-8081
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60133188103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical