Provider Demographics
NPI:1447548789
Name:WINDECKER-NELSON, ELIZABETH LOUISE (PHD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:WINDECKER-NELSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1126
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-1126
Mailing Address - Country:US
Mailing Address - Phone:360-320-0595
Mailing Address - Fax:
Practice Address - Street 1:6500 SILLS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-8521
Practice Address - Country:US
Practice Address - Phone:360-320-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60166980106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist