Provider Demographics
NPI:1871043596
Name:MAKHIAWALA, KENYA (PHD)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:MAKHIAWALA
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 1:22903 27TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7273
Mailing Address - Country:US
Mailing Address - Phone:734-788-5319
Mailing Address - Fax:
Practice Address - Street 1:1200 5TH AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3132
Practice Address - Country:US
Practice Address - Phone:206-374-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60603757103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent