Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003179565 |
---|---|
Provider Name | Jessie Aman Cabasag |
First Address | Seattle, WA 98101-2831 |
Second Address | Seattle, WA 98101-2831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2012 |
Last Update Date | 20/06/2012 |