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General NPI Number Information
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NPI Number | 1023724853
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Entity Type | Individual
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Provider Name | MIKAELA NOEL ALDACO-FOWLER MA, LMFTA
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Gender | Female
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 6532 NE 196TH PL
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City | KENMORE
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State | WA
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Zip | 98028-8653
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Country | US
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Telephone | 425-866-0548
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Fax |
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Provider Business Mailing Address
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Address Line | 6532 NE 196TH PL
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City | KENMORE
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State | WA
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Zip | 98028-8653
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Country | US
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Telephone | 425-866-0548
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | MG61392718
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License Number State | WA
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