Provider Demographics
NPI:1427249606
Name:SAKUMA, YOLANDA (LMP)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:SAKUMA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 VINE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-2532
Mailing Address - Country:US
Mailing Address - Phone:360-421-0435
Mailing Address - Fax:
Practice Address - Street 1:113 S 11TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4025
Practice Address - Country:US
Practice Address - Phone:360-421-0435
Practice Address - Fax:360-404-3906
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
WAMA00019667225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty