Provider Demographics
NPI:1215629829
Name:ST JOHN, ANNIKA RACHEL (LICSW)
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:RACHEL
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 N 28TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-3915
Mailing Address - Country:US
Mailing Address - Phone:209-247-8435
Mailing Address - Fax:
Practice Address - Street 1:4801 N 28TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-3915
Practice Address - Country:US
Practice Address - Phone:209-247-8435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA612973551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical