Active NPI
Mendyann Boettcher Minjarez, PH.D.
- Clinical Psychologist
- Seattle, WA
National Provider Identifier
1699780486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY 60121906
- Practice address
- 4909 25TH Ave NE
Suite 120
Seattle, WA 98105-4107 - Phone
- (206) 987-7177
- Fax
- (206) 987-8081
- NPI assigned
- Jul 30, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY 60121906 | WA | Primary |
| Clinical Psychologist | 103TC0700X | PSY 20769 | CA |
Addresses
Primary practice location
4909 25TH Ave NE
Suite 120
Seattle, WA 98105-4107
Mailing address
PO Box 5371
M/S Cac (Seattle Children'S Autism Center)
Seattle, WA 98145-5005
Phone (206) 987-7177
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 20769 | CA | MD | Clinical Psychologist |
| PY 60121906 | WA | MD | Clinical Psychologist |
Interoperability endpoints
- mminjarez35888@direct.seattlechildrens.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Seattle, WA
- NPI 1255449963
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367193600000",
"number": "1699780486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5371",
"address_2": "M/S CAC (SEATTLE CHILDREN'S AUTISM CENTER)",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981455005",
"telephone_number": "206-987-7177",
"fax_number": "206-987-8081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4909 25TH AVE NE",
"address_2": "SUITE 120",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981054107",
"telephone_number": "206-987-7177",
"fax_number": "206-987-8081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINJAREZ",
"first_name": "MENDYANN",
"middle_name": "BOETTCHER",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-30",
"last_updated": "2013-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY 60121906",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 20769",
"primary": false
}
],
"identifiers": [],
"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 Apr 29, 2013; 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.