Provider Demographics
NPI:1437430972
Name:ILIMALEOTA, JUNAE LYNETTE (MA)
Entity Type:Individual
Prefix:MS
First Name:JUNAE
Middle Name:LYNETTE
Last Name:ILIMALEOTA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:JUNAE
Other - Middle Name:LYNETTE
Other - Last Name:DRAPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3322 BROADWAY # MS 68
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4425
Mailing Address - Country:US
Mailing Address - Phone:425-349-6100
Mailing Address - Fax:425-349-6101
Practice Address - Street 1:3322 BROADWAY # MS 68
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4425
Practice Address - Country:US
Practice Address - Phone:425-349-6100
Practice Address - Fax:425-349-6101
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2116065Medicaid