Provider Demographics
NPI:1760043889
Name:DALE, YESENIA ZENITH
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:ZENITH
Last Name:DALE
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 1:407 VALLEY AVE NE APT V303
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-6946
Mailing Address - Country:US
Mailing Address - Phone:610-790-3297
Mailing Address - Fax:
Practice Address - Street 1:515 W HARRISON ST STE 109
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4403
Practice Address - Country:US
Practice Address - Phone:253-856-9000
Practice Address - Fax:253-520-6647
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health