Provider Demographics
NPI:1003959891
Name:GUJI, MAKIKO
Entity Type:Individual
Prefix:
First Name:MAKIKO
Middle Name:
Last Name:GUJI
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 1:7191 WAGNER WAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8330
Mailing Address - Country:US
Mailing Address - Phone:253-514-8068
Mailing Address - Fax:253-514-8078
Practice Address - Street 1:3819 100TH ST SW
Practice Address - Street 2:SUITE 7-C
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4470
Practice Address - Country:US
Practice Address - Phone:253-588-7911
Practice Address - Fax:253-984-6774
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003684103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPY00003684OtherWA STATE LICENSE