Provider Demographics
NPI:1104381243
Name:DISKIN, MICHELLE KIM (MS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:KIM
Last Name:DISKIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 N 77TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4906
Mailing Address - Country:US
Mailing Address - Phone:415-828-4304
Mailing Address - Fax:
Practice Address - Street 1:5306 BALLARD AVE NW STE 403
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4367
Practice Address - Country:US
Practice Address - Phone:415-828-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-03
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60420736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health