Individual
ISAIAH F OTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDPT
Contact information
Practice address
27203 216TH AVE SE STE 5, MAPLE VALLEY, WA 98038-3273
(425) 584-7570
Mailing address
27203 216TH AVE SE STE 5, MAPLE VALLEY, WA 98038-3273
(425) 584-7570
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO61029070
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
N/A
WA
Enumeration date
05/28/2020
Last updated
05/28/2020
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