Healthcare Provider Details

I. General information

NPI: 1952927329
Provider Name (Legal Business Name): CASSIDY JO SONKENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 MAIN ST
EDMONDS WA
98020-3166
US

IV. Provider business mailing address

3901 NE 45TH ST
SEATTLE WA
98105-5150
US

V. Phone/Fax

Practice location:
  • Phone: 801-897-3472
  • Fax:
Mailing address:
  • Phone: 801-897-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70109350
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: