Provider Demographics
NPI:1265902001
Name:ARMENDARIZ, EDITH (AAC)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:ARMENDARIZ
Suffix:
Gender:F
Credentials:AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 100TH ST SE STE A2
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3832
Mailing Address - Country:US
Mailing Address - Phone:425-312-0277
Mailing Address - Fax:425-312-0280
Practice Address - Street 1:1920 100TH ST SE STE A2
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3832
Practice Address - Country:US
Practice Address - Phone:425-312-0277
Practice Address - Fax:425-312-0280
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WACG60885620101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor