Doctor Name: | SONYA IBABAO |
NPI Number: | 1134363963 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | RC60026709 |
Business Practice Address: | 22 Mccleary Rd Mccleary, WA - 985579301 |
Business Phone Number: | 3604709334 |
Business Fax Number: | |
Mailing Address: | 22 Mccleary Rd, MCCLEARY |
State: | WA |
Postal Code: | 985579301 |
Phone Number: | 3604709334 |
Fax Number: | |
NPI Enumeration Date: | 04/23/2009 |
NPI Last Update Date: | 04/23/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | RC60026709 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |