Healthcare Provider Details

I. General information

NPI: 1346177763
Provider Name (Legal Business Name): SIDRA AELE ING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 PACIFIC AVE STE 212
TACOMA WA
98402-4433
US

IV. Provider business mailing address

11962 44TH AVE S
TUKWILA WA
98178-3477
US

V. Phone/Fax

Practice location:
  • Phone: 253-480-5506
  • Fax: 253-480-5507
Mailing address:
  • Phone: 253-480-5506
  • Fax: 253-480-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG.70027770
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCG.70027770
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: