Healthcare Provider Details

I. General information

NPI: 1225653603
Provider Name (Legal Business Name): JUDY WAMBUI NJOKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WARREN AVE STE 200
BREMERTON WA
98337-1467
US

IV. Provider business mailing address

1928 E 56TH ST APT 21
TACOMA WA
98404-5103
US

V. Phone/Fax

Practice location:
  • Phone: 360-478-2366
  • Fax:
Mailing address:
  • Phone: 253-455-6824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61048826
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: