Healthcare Provider Details

I. General information

NPI: 1962994681
Provider Name (Legal Business Name): TAJA ESTRADA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 12/11/2021
Certification Date: 12/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7222 LINDEN AVENUE N SUITE A
SEATTLE WA
98103
US

IV. Provider business mailing address

7222 LINDEN AVENUE N SUITE A
SEATTLE WA
98103
US

V. Phone/Fax

Practice location:
  • Phone: 206-627-0033
  • Fax:
Mailing address:
  • Phone: 206-627-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY61047857
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY61047857
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: