Provider Demographics
NPI:1154653608
Name:VISKOVA, YEKATERINA (MA)
Entity Type:Individual
Prefix:MRS
First Name:YEKATERINA
Middle Name:
Last Name:VISKOVA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 44TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4116
Mailing Address - Country:US
Mailing Address - Phone:425-533-7202
Mailing Address - Fax:425-227-5524
Practice Address - Street 1:4505 44TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4116
Practice Address - Country:US
Practice Address - Phone:425-533-7202
Practice Address - Fax:425-227-5524
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60116260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health