Provider Demographics
NPI:1477011138
Name:BJERKE, KARIS CORIN (CDP)
Entity Type:Individual
Prefix:
First Name:KARIS
Middle Name:CORIN
Last Name:BJERKE
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27203 216TH AVE SE STE 5
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-3273
Mailing Address - Country:US
Mailing Address - Phone:425-584-7570
Mailing Address - Fax:425-584-7570
Practice Address - Street 1:27203 216TH AVE SE STE 5
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-3273
Practice Address - Country:US
Practice Address - Phone:425-584-7570
Practice Address - Fax:425-584-7570
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WACP60488450101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program