Healthcare Provider Details

I. General information

NPI: 1023597929
Provider Name (Legal Business Name): COURTNEY YASUNAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98144-6847
US

IV. Provider business mailing address

3220 CALIFORNIA AVE SW APT 532
SEATTLE WA
98116-3383
US

V. Phone/Fax

Practice location:
  • Phone: 206-695-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCO60820892
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: