Provider Demographics
NPI:1881014439
Name:RUDY, MARIKO
Entity Type:Individual
Prefix:
First Name:MARIKO
Middle Name:
Last Name:RUDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIKO
Other - Middle Name:
Other - Last Name:ITCHKAWICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31955 STATE ROUTE 20
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31955 STATE ROUTE 20
Practice Address - Street 2:SUITE 3
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5211
Practice Address - Country:US
Practice Address - Phone:703-303-7859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor