Provider Demographics
NPI:1619331543
Name:TASHKA, TICIA LUCA ANJEA (LMP)
Entity Type:Individual
Prefix:
First Name:TICIA
Middle Name:LUCA ANJEA
Last Name:TASHKA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:LATICIA
Other - Middle Name:M
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1666 EAST OLIVE WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102
Mailing Address - Country:US
Mailing Address - Phone:206-856-7926
Mailing Address - Fax:
Practice Address - Street 1:1666 EAST OLIVE WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102
Practice Address - Country:US
Practice Address - Phone:206-856-7926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60686525225700000X
WAMA60686525225700000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA225700000XOtherWA
WA101YM0800XMedicaid