Healthcare Provider Details

I. General information

NPI: 1295139574
Provider Name (Legal Business Name): MS. MARISSA BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 AUBURN WAY N
AUBURN WA
98002-1311
US

IV. Provider business mailing address

6400 SOUTHCENTER BLVD FL 1
TUKWILA WA
98188-2547
US

V. Phone/Fax

Practice location:
  • Phone: 253-876-8900
  • Fax:
Mailing address:
  • Phone: 206-901-2041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPR70107295
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: