Provider Demographics
NPI:1053861955
Name:VANESSA DZIVAKWE, PHD, PLLC
Entity Type:Organization
Organization Name:VANESSA DZIVAKWE, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DZIVAKWE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-329-5255
Mailing Address - Street 1:509 OLIVE WAY STE 204
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1726
Mailing Address - Country:US
Mailing Address - Phone:206-329-5255
Mailing Address - Fax:206-726-1878
Practice Address - Street 1:509 OLIVE WAY STE 204
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1726
Practice Address - Country:US
Practice Address - Phone:206-329-5255
Practice Address - Fax:206-726-1878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60666097251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health