Provider Demographics
NPI:1760567580
Name:TOSHIMA, MICHELLE TOSHIKA (PHD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TOSHIKA
Last Name:TOSHIMA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12333 NE 130TH LN STE 225
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7467
Mailing Address - Country:US
Mailing Address - Phone:425-899-5350
Mailing Address - Fax:
Practice Address - Street 1:12333 NE 130TH LN STE 225
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7467
Practice Address - Country:US
Practice Address - Phone:425-899-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001576103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
9696OtherINTERNAL ID MOTOR VEHICLE ID
WA8352965Medicaid
R30081Medicare UPIN
8870243Medicare UPIN
107622Medicare ID - Type Unspecified