Provider Demographics
NPI:1407641277
Name:KIBREAB, YIZU TESFAI (NA)
Entity type:Individual
Prefix:
First Name:YIZU
Middle Name:TESFAI
Last Name:KIBREAB
Suffix:
Gender:
Credentials:NA
Other - Prefix:
Other - First Name:YIRGALEM
Other - Middle Name:T
Other - Last Name:KIBREAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NA
Mailing Address - Street 1:21905 55TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-3211
Mailing Address - Country:US
Mailing Address - Phone:425-773-0227
Mailing Address - Fax:
Practice Address - Street 1:11410 NE 122ND WAY STE 100
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6927
Practice Address - Country:US
Practice Address - Phone:425-560-4005
Practice Address - Fax:425-560-4005
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1041C0700X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical