Provider Demographics
NPI:1205388048
Name:HERNANDEZ-KAFKA, EIMMY KAREN (CP 60329292)
Entity Type:Individual
Prefix:MRS
First Name:EIMMY
Middle Name:KAREN
Last Name:HERNANDEZ-KAFKA
Suffix:
Gender:F
Credentials:CP 60329292
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N MISSION ST STE 106
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-6610
Mailing Address - Country:US
Mailing Address - Phone:509-888-4404
Mailing Address - Fax:509-888-2741
Practice Address - Street 1:610 N MISSION ST STE 106
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6610
Practice Address - Country:US
Practice Address - Phone:509-888-4404
Practice Address - Fax:509-888-2741
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60329292101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)