Healthcare Provider Details

I. General information

NPI: 1720761109
Provider Name (Legal Business Name): DENIESSE JOAQUIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 15TH AVE SW
SEATTLE WA
98106-2576
US

IV. Provider business mailing address

9650 15TH AVE SW
SEATTLE WA
98106-2576
US

V. Phone/Fax

Practice location:
  • Phone: 206-965-1055
  • Fax: 206-965-1032
Mailing address:
  • Phone: 206-965-1055
  • Fax: 206-965-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC17110
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number70018200
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: