Provider Demographics
NPI:1699121616
Name:SEDOV, TARA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:SEDOV
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9757 NE JUANITA DR STE 214
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4291
Mailing Address - Country:US
Mailing Address - Phone:425-943-9360
Mailing Address - Fax:206-764-0516
Practice Address - Street 1:9757 NE JUANITA DR STE 214
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4291
Practice Address - Country:US
Practice Address - Phone:425-943-9360
Practice Address - Fax:425-968-1259
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC608200111041C0700X
WALW610731381041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health