Healthcare Provider Details

I. General information

NPI: 1295911766
Provider Name (Legal Business Name): JACQUELIN MICHELLE HIGGINS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELIN MICHELLE MUNOZ

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4238 AUBURN WAY N
AUBURN WA
98002
US

IV. Provider business mailing address

1600 E OLIVE ST
SEATTLE WA
98122-2735
US

V. Phone/Fax

Practice location:
  • Phone: 253-876-7600
  • Fax: 253-876-7610
Mailing address:
  • Phone: 206-302-2200
  • Fax: 206-302-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60160343
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberRC00058273
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: