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NPI Code Detail

MEDICARE: CORINE CHIEMI GUSHIKUMA MSW, M.ED, BCBA

MEDICARE: CORINE CHIEMI GUSHIKUMA MSW, M.ED, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2103K00000XBehavior AnalystBA61033085WA

General Provider Information

NPI Number : 1962973388
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORINE CHIEMI GUSHIKUMA MSW, M.ED, BCBA
Provider Business Mailing Address
First Line : 3918 14TH AVE S
Second Line :
City : SEATTLE
State : WA
Zip : 98108-1428
Country : US
Telephone Number : 808-781-0652
Fax Number :
Provider Business Practice Location Address
First Line : 3111 BROAD ST
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-8342
Country : US
Telephone Number : 808-781-0652
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2018
Last Update Date : 03/13/2020

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