Active NPI
Aliisa Breisch, PSY.D.
- Psychologist
- Mountlake Terrace, WA
National Provider Identifier
1518335330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY60543485
- Practice address
- 21907 64TH Ave W
Suite 200
Mountlake Terrace, WA 98043-2200 - Phone
- (425) 640-7009
- NPI assigned
- Sep 10, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY60543485 | WA | Primary |
Addresses
Primary practice location
21907 64TH Ave W
Suite 200
Mountlake Terrace, WA 98043-2200
Mailing address
15229 50TH Ave W
Edmonds, WA 98026-4412
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY60543485 | WA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441843200000",
"number": "1518335330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15229 50TH AVE W",
"city": "EDMONDS",
"state": "WA",
"postal_code": "980264412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21907 64TH AVE W",
"address_2": "SUITE 200",
"city": "MOUNTLAKE TERRACE",
"state": "WA",
"postal_code": "980432200",
"telephone_number": "425-640-7009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREISCH",
"first_name": "ALIISA",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-10",
"last_updated": "2015-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WA",
"license": "PY60543485",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mountlake Terrace, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.