Provider Demographics
NPI:1487275715
Name:MONAHAN, EMELIA M
Entity type:Individual
Prefix:
First Name:EMELIA
Middle Name:M
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18806 SE 42ND ST
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-9366
Mailing Address - Country:US
Mailing Address - Phone:425-301-6470
Mailing Address - Fax:
Practice Address - Street 1:5436 232ND AVE SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6220
Practice Address - Country:US
Practice Address - Phone:425-301-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61062454106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician