Provider Demographics
NPI:1346545415
Name:DEMKO, GISELA LOURDES (MA)
Entity Type:Individual
Prefix:MRS
First Name:GISELA
Middle Name:LOURDES
Last Name:DEMKO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:GIGIA
Other - Middle Name:LOURDES
Other - Last Name:DEMKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6912
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98417-0388
Mailing Address - Country:US
Mailing Address - Phone:360-402-7527
Mailing Address - Fax:
Practice Address - Street 1:2116 CATON WAY SW STE 102
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1176
Practice Address - Country:US
Practice Address - Phone:360-402-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60108626101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health