Provider Demographics
NPI:1295202547
Name:JOHN, FRAUKE DOROTHEA
Entity Type:Individual
Prefix:
First Name:FRAUKE
Middle Name:DOROTHEA
Last Name:JOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FRAUKE
Other - Middle Name:DOROTHEA
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9708 NE 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:424-386-1922
Mailing Address - Fax:206-901-2010
Practice Address - Street 1:9708 NE 1ST STREET
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:424-386-1922
Practice Address - Fax:206-302-2610
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2021-02-11
Deactivation Date:2019-05-31
Deactivation Code:
Reactivation Date:2021-01-22
Provider Licenses
StateLicense IDTaxonomies
WAMC61005022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health