Healthcare Provider Details

I. General information

NPI: 1700382488
Provider Name (Legal Business Name): SOPHIE MARIE BJORKQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 BOYLSTON AVE E APT 101
SEATTLE WA
98102
US

IV. Provider business mailing address

431 BOYLSTON AVE E APT 101
SEATTLE WA
98102-4903
US

V. Phone/Fax

Practice location:
  • Phone: 303-905-0610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC060888907
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60799007
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: