Provider Demographics
NPI:1467006825
Name:YIKEALO, TIMNIT YONAS
Entity Type:Individual
Prefix:
First Name:TIMNIT
Middle Name:YONAS
Last Name:YIKEALO
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 1:821 N STANLEY ST APT A206
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-8935
Mailing Address - Country:US
Mailing Address - Phone:509-724-9268
Mailing Address - Fax:
Practice Address - Street 1:1819 E SPRINGFIELD AVE STE H
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2954
Practice Address - Country:US
Practice Address - Phone:509-999-5657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-23-67584103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst