Provider Demographics
NPI:1356810345
Name:ASTUDILLO, ALLYSA TEJANO
Entity type:Individual
Prefix:
First Name:ALLYSA
Middle Name:TEJANO
Last Name:ASTUDILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7133 MONTEVISTA DR SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8224
Mailing Address - Country:US
Mailing Address - Phone:206-307-9819
Mailing Address - Fax:
Practice Address - Street 1:4746 11TH AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4660
Practice Address - Country:US
Practice Address - Phone:206-535-8876
Practice Address - Fax:206-486-9938
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst