Provider Demographics
NPI:1780756973
Name:O'CONNOR, ELSA (PHD, EDD)
Entity type:Individual
Prefix:DR
First Name:ELSA
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:PHD, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14464 NE 12TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4007
Mailing Address - Country:US
Mailing Address - Phone:425-747-7493
Mailing Address - Fax:
Practice Address - Street 1:18500 156TH AVE NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-4459
Practice Address - Country:US
Practice Address - Phone:425-481-5700
Practice Address - Fax:425-481-2157
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002357103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling