Healthcare Provider Details

I. General information

NPI: 1982560751
Provider Name (Legal Business Name): MOHAMED-DEEQ ABDULLAHI OLOW ED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17620 SE 265TH CT
COVINGTON WA
98042-5639
US

IV. Provider business mailing address

17620 SE 265TH CT
COVINGTON WA
98042-5639
US

V. Phone/Fax

Practice location:
  • Phone: 253-293-1273
  • Fax:
Mailing address:
  • Phone: 253-293-1273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBHA.FS.70019618
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: