Provider Demographics
NPI:1558815688
Name:TRAKIC, NEV (MA)
Entity Type:Individual
Prefix:
First Name:NEV
Middle Name:
Last Name:TRAKIC
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:NEVENA
Other - Middle Name:
Other - Last Name:TRAKIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4120 STONE WAY N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8014
Mailing Address - Country:US
Mailing Address - Phone:206-461-3707
Mailing Address - Fax:
Practice Address - Street 1:4120 STONE WAY N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8014
Practice Address - Country:US
Practice Address - Phone:206-461-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60412270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health