Provider Demographics
NPI:1881895134
Name:JANSON, VIDA (MD)
Entity type:Individual
Prefix:
First Name:VIDA
Middle Name:
Last Name:JANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1836 WESTLAKE AVE N
Mailing Address - Street 2:SUITE #204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2755
Mailing Address - Country:US
Mailing Address - Phone:206-213-0071
Mailing Address - Fax:206-284-9475
Practice Address - Street 1:1836 WESTLAKE AVE N
Practice Address - Street 2:SUITE #204
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2755
Practice Address - Country:US
Practice Address - Phone:206-213-0071
Practice Address - Fax:206-284-9475
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000440162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry