MS. KIMMY JO LAKE CDP NPI 1629414917

NPI Information

NPI: 1629414917
Provider Name: MS. KIMMY JO LAKE, CDP
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
758 ST HELENS AVE
TACOMA, WA
ZIP 98402
Phone: (253) 274-0484
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MS. Kimmy Jo Lake, CDP is an addiction (substance use disorder) counselor in Tacoma, WA. MS. Kimmy Jo Lake, CDP NPI is 1629414917. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

758 ST HELENS AVE
TACOMA, WA
ZIP 98402-706
Phone: (253) 274-0484
Fax: (253) 274-1457

The enumeration date for this NPI number is 5/14/2013 and was last updated on 5/14/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	CP60311481	WASHINGTON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1003939034	MEDICAID	WASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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