Provider Demographics
NPI:1881577310
Name:BOUIE, JAKOBIE LATRELL
Entity type:Individual
Prefix:
First Name:JAKOBIE
Middle Name:LATRELL
Last Name:BOUIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11922 185TH ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9179
Mailing Address - Country:US
Mailing Address - Phone:253-259-6657
Mailing Address - Fax:
Practice Address - Street 1:4508 AUBURN WAY N STE B
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1381
Practice Address - Country:US
Practice Address - Phone:425-246-7038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician