Provider Demographics
NPI:1598511990
Name:MIFFLIN, BIANCA CELESTE
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:CELESTE
Last Name:MIFFLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8439 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1317
Mailing Address - Country:US
Mailing Address - Phone:210-900-6042
Mailing Address - Fax:
Practice Address - Street 1:737 FAWCETT AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5503
Practice Address - Country:US
Practice Address - Phone:253-396-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician