Provider Demographics
NPI:1023724853
Name:ALDACO-FOWLER, MIKAELA NOEL (MA, LMFTA)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:NOEL
Last Name:ALDACO-FOWLER
Suffix:
Gender:F
Credentials:MA, LMFTA
Other - Prefix:
Other - First Name:MIKAELA
Other - Middle Name:NOEL
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LMFTA
Mailing Address - Street 1:6532 NE 196TH PL
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-8653
Mailing Address - Country:US
Mailing Address - Phone:425-866-0548
Mailing Address - Fax:
Practice Address - Street 1:6532 NE 196TH PL
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-8653
Practice Address - Country:US
Practice Address - Phone:425-866-0548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61392718103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily