Healthcare Provider Details

I. General information

NPI: 1780479501
Provider Name (Legal Business Name): ANN SHEILA WAMBUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12104 172ND STREET CT E
PUYALLUP WA
98374-4509
US

IV. Provider business mailing address

12104 172ND STREET CT E
PUYALLUP WA
98374-4509
US

V. Phone/Fax

Practice location:
  • Phone: 253-440-1438
  • Fax: 253-364-1918
Mailing address:
  • Phone: 253-391-4602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number70076162
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: