Provider Demographics
NPI:1376708784
Name:ITO, YVONNE MARIE (MSW, DWS-ABD)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:MARIE
Last Name:ITO
Suffix:
Gender:F
Credentials:MSW, DWS-ABD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 N WEST AVE # 124
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1251
Mailing Address - Country:US
Mailing Address - Phone:425-870-3811
Mailing Address - Fax:
Practice Address - Street 1:187 GLENN HWY
Practice Address - Street 2:
Practice Address - City:GLENNALLEN
Practice Address - State:AK
Practice Address - Zip Code:99588-0005
Practice Address - Country:US
Practice Address - Phone:907-822-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60164257101YM0800X
AK104100000X
WALW60490731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker