Healthcare Provider Details

I. General information

NPI: 1578385969
Provider Name (Legal Business Name): YEKATERINA KUKHTO LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 BOTHELL EVERETT HWY STE 360
MILL CREEK WA
98012-1577
US

IV. Provider business mailing address

16000 BOTHELL EVERETT HWY STE 360
MILL CREEK WA
98012-1577
US

V. Phone/Fax

Practice location:
  • Phone: 425-245-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61606638
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: