Provider Demographics
NPI:1902622863
Name:GAKURU, PRISCILLAH W
Entity type:Individual
Prefix:
First Name:PRISCILLAH
Middle Name:W
Last Name:GAKURU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18002 116TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-6566
Mailing Address - Country:US
Mailing Address - Phone:253-880-7402
Mailing Address - Fax:
Practice Address - Street 1:18002 116TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-6566
Practice Address - Country:US
Practice Address - Phone:253-880-7402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor