Healthcare Provider Details

I. General information

NPI: 1023870524
Provider Name (Legal Business Name): MIKAILAH ARIEL DYKOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 MERIDIAN AVE N STE G11
SEATTLE WA
98133-9008
US

IV. Provider business mailing address

4515 W RAYE ST # B
SEATTLE WA
98199-3009
US

V. Phone/Fax

Practice location:
  • Phone: 206-302-2900
  • Fax:
Mailing address:
  • Phone: 719-960-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: