Provider Demographics
NPI:1356743132
Name:TEDROW, AILEEN (LMHCA)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:TEDROW
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:
Other - Last Name:ADAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23107 100TH AVE W
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-5062
Mailing Address - Country:US
Mailing Address - Phone:425-774-8049
Mailing Address - Fax:425-953-4340
Practice Address - Street 1:23107 100TH AVE W
Practice Address - Street 2:SUITE 5
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5062
Practice Address - Country:US
Practice Address - Phone:425-774-8049
Practice Address - Fax:425-953-4340
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60408965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health