Provider Demographics
NPI:1316329287
Name:CHUKWU, IFEANYI CHARLES (MED)
Entity type:Individual
Prefix:MR
First Name:IFEANYI
Middle Name:CHARLES
Last Name:CHUKWU
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8862
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-0056
Mailing Address - Country:US
Mailing Address - Phone:206-234-2281
Mailing Address - Fax:253-638-1302
Practice Address - Street 1:23745 225TH WAY SE
Practice Address - Street 2:STE. #205C
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5294
Practice Address - Country:US
Practice Address - Phone:425-433-6121
Practice Address - Fax:253-638-1302
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60160585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health