Provider Demographics
NPI:1366041048
Name:MOKLER, SHAWNA LYNN (SUDP)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:LYNN
Last Name:MOKLER
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 CENTRAL AVE N STE 215
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-2014
Mailing Address - Country:US
Mailing Address - Phone:425-429-3004
Mailing Address - Fax:425-671-6198
Practice Address - Street 1:841 CENTRAL AVE N STE 215
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2014
Practice Address - Country:US
Practice Address - Phone:800-858-6702
Practice Address - Fax:425-671-6198
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60956720101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)