MEDICARE: KRISTIN CHERRY JACKSON LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LF70014165	WA

General Provider Information

NPI Number	:	1073214433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN CHERRY JACKSON LMFT

Provider Business Mailing Address
First Line	:	1607 DEXTER AVE N STE 1C
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-6202
Country	:	US
Telephone Number	:	206-351-3199
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 DEXTER AVE N STE 1C
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-6202
Country	:	US
Telephone Number	:	425-405-5169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	12/03/2025

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