Provider Demographics
NPI:1427165646
Name:LANDRUM, ELIZABETH E (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:E
Last Name:LANDRUM
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 1:555 DAYTON ST
Mailing Address - Street 2:STE D
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3601
Mailing Address - Country:US
Mailing Address - Phone:425-778-8775
Mailing Address - Fax:
Practice Address - Street 1:555 DAYTON ST
Practice Address - Street 2:STE D
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3601
Practice Address - Country:US
Practice Address - Phone:425-778-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001804103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist