Provider Demographics
NPI:1124634969
Name:WONG-VICUNA, JOSSIE JENIFFER
Entity type:Individual
Prefix:
First Name:JOSSIE
Middle Name:JENIFFER
Last Name:WONG-VICUNA
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 1:3001 S 288TH STREET
Mailing Address - Street 2:201
Mailing Address - City:FERDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:206-249-2707
Mailing Address - Fax:206-212-7836
Practice Address - Street 1:3001 S 288TH STREET
Practice Address - Street 2:201
Practice Address - City:FERDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:206-249-2707
Practice Address - Fax:206-212-7836
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC14991171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter