Provider Demographics
NPI:1376135806
Name:KANESHIRO, DEIJAH
Entity type:Individual
Prefix:
First Name:DEIJAH
Middle Name:
Last Name:KANESHIRO
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:PO BOX 1447
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0378
Mailing Address - Country:US
Mailing Address - Phone:360-999-7429
Mailing Address - Fax:
Practice Address - Street 1:618 W MARKET ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6016
Practice Address - Country:US
Practice Address - Phone:360-261-6931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health