Healthcare Provider Details

I. General information

NPI: 1235302530
Provider Name (Legal Business Name): CINDY WUFLESTAD MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18402 103RD AVE NE
BOTHELL WA
98011-3410
US

IV. Provider business mailing address

18402 103RD AVE NE
BOTHELL WA
98011-3410
US

V. Phone/Fax

Practice location:
  • Phone: 425-770-2114
  • Fax:
Mailing address:
  • Phone: 425-770-2114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00010667
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: