Provider Demographics
NPI:1144285446
Name:MINNO, DENNIS STEPHEN (MA)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:STEPHEN
Last Name:MINNO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20232 SE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-9675
Mailing Address - Country:US
Mailing Address - Phone:425-392-0790
Mailing Address - Fax:425-837-8559
Practice Address - Street 1:10021 NE 124TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6725
Practice Address - Country:US
Practice Address - Phone:425-455-2960
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005416101YM0800X
WALF00001047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist