Healthcare Provider Details

I. General information

NPI: 1053078667
Provider Name (Legal Business Name): ELIZABETH LANDIN MICHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 EVERGREEN WAY STE Z150
EVERETT WA
98204-3889
US

IV. Provider business mailing address

9930 EVERGREEN WAY STE Z150
EVERETT WA
98204-3889
US

V. Phone/Fax

Practice location:
  • Phone: 425-347-5121
  • Fax:
Mailing address:
  • Phone: 425-347-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: