Healthcare Provider Details

I. General information

NPI: 1518374214
Provider Name (Legal Business Name): MICAH ARIA VACATIO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 HIDEAWAY PL
WENATCHEE WA
98801-1073
US

IV. Provider business mailing address

1920 HIDEAWAY PL
WENATCHEE WA
98801-1073
US

V. Phone/Fax

Practice location:
  • Phone: 425-368-9397
  • Fax: 425-217-0676
Mailing address:
  • Phone: 425-368-9397
  • Fax: 425-217-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60806628
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: