Healthcare Provider Details

I. General information

NPI: 1134563547
Provider Name (Legal Business Name): PHAEDRA ELIZABETH PASCOE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 09/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9706 4TH AVE NE STE 303
SEATTLE WA
98115
US

IV. Provider business mailing address

6400 SOUTHCENTER BLVD
TUKWILA WA
98188-2547
US

V. Phone/Fax

Practice location:
  • Phone: 206-302-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD60580430
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60580430
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: