Provider Demographics
NPI:1962896902
Name:SALAZAR, ANDREA C (PHD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:C
Other - Last Name:SALAZAR-NUNEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1220
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-1220
Mailing Address - Country:US
Mailing Address - Phone:206-486-2058
Mailing Address - Fax:
Practice Address - Street 1:2207 NE 65TH ST STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7097
Practice Address - Country:US
Practice Address - Phone:206-764-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60878190103TC1900X
WACG60450410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health