Healthcare Provider Details

I. General information

NPI: 1992187140
Provider Name (Legal Business Name): JACOB BJORK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12040 98TH AVE NE STE 204
KIRKLAND WA
98034-4290
US

IV. Provider business mailing address

12040 98TH AVE NE STE 204
KIRKLAND WA
98034-4290
US

V. Phone/Fax

Practice location:
  • Phone: 425-658-3016
  • Fax:
Mailing address:
  • Phone: 425-658-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCG60575278
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: