Provider Demographics
NPI:1447913850
Name:JOHN, ESTHER VIRGINIA (MED)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:VIRGINIA
Last Name:JOHN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6940 37TH AVE S APT 218
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-6446
Mailing Address - Country:US
Mailing Address - Phone:206-245-3871
Mailing Address - Fax:
Practice Address - Street 1:6940 37TH AVE S APT 218
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-6446
Practice Address - Country:US
Practice Address - Phone:206-245-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health