Active NPI
Monica Elena Edenholm, LMFTA, PA-C
- Marriage & Family Therapist
- Seattle, WA
National Provider Identifier
1609812536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 2704 NE 143Rd St
Seattle, WA 98125-3523 - Phone
- (206) 915-3253
- NPI assigned
- Jun 21, 2006
- Last updated
- Sep 12, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10004541 | WA | |
| Medical Physician Assistant | 363AM0700X | PA10004541 | WA | |
| Marriage & Family Therapist | 106H00000X | WA | Primary |
Addresses
Primary practice location
2704 NE 143Rd St
Seattle, WA 98125-3523
Mailing address
2704 NE 143Rd St
Seattle, WA 98125-3523
Phone (206) 915-3253
Other practice location 1
4004 Colby Ave
Everett, WA 98201-6203
Phone (425) 259-0966
Other practice location 2
1201 N 175th St
Shoreline, WA 98133-5064
Phone (206) 401-3142
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1014354 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694476800000",
"number": "1609812536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2704 NE 143RD ST",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981253523",
"telephone_number": "206-915-3253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2704 NE 143RD ST",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981253523",
"telephone_number": "206-915-3253"
}
],
"practiceLocations": [
{
"address_1": "4004 Colby Ave",
"address_purpose": "LOCATION",
"city": "Everett",
"state": "WA",
"postal_code": "982016203",
"country_code": "US",
"telephone_number": "425-259-0966",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1201 N 175th St",
"address_purpose": "LOCATION",
"city": "Shoreline",
"state": "WA",
"postal_code": "981335064",
"country_code": "US",
"telephone_number": "206-401-3142",
"fax_number": "206-401-3201",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "EDENHOLM",
"first_name": "MONICA",
"middle_name": "ELENA",
"name_prefix": "Ms.",
"credential": "LMFTA, PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-21",
"last_updated": "2023-09-12",
"certification_date": "2023-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA10004541",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "WA",
"license": "PA10004541",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "WA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1014354",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.