MEDICARE: DR. JEN M REICHENBACH SELF PHD LICSW

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	1041C0700X	Clinical Social Worker	LW60171267	WA

General Provider Information

NPI Number	:	1942747878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEN M REICHENBACH SELF PHD LICSW

Provider Business Mailing Address
First Line	:	8856 13TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-2439
Country	:	US
Telephone Number	:	206-949-8921
Fax Number	:

Provider Business Practice Location Address
First Line	:	8856 13TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-2439
Country	:	US
Telephone Number	:	206-949-8921
Fax Number	:

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

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	01/30/2017

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