Provider Demographics
NPI:1326334723
Name:NAWATA, AKIKO
Entity Type:Individual
Prefix:
First Name:AKIKO
Middle Name:
Last Name:NAWATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 292
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98291-0292
Mailing Address - Country:US
Mailing Address - Phone:425-471-1591
Mailing Address - Fax:360-568-1654
Practice Address - Street 1:17839 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4814
Practice Address - Country:US
Practice Address - Phone:425-471-1591
Practice Address - Fax:360-568-1654
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60209058101YM0800X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral