Provider Demographics
NPI:1104346352
Name:MAKONNEN, BERHANE
Entity type:Individual
Prefix:
First Name:BERHANE
Middle Name:
Last Name:MAKONNEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 S ORCAS ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2437
Mailing Address - Country:US
Mailing Address - Phone:206-263-9426
Mailing Address - Fax:206-296-0577
Practice Address - Street 1:14350 SE EASTGATE WAY
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-6458
Practice Address - Country:US
Practice Address - Phone:206-263-9426
Practice Address - Fax:206-296-0577
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60755113104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker