Healthcare Provider Details

I. General information

NPI: 1912823774
Provider Name (Legal Business Name): JELISSA IMAN-OLEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11911 NE 1ST ST STE 205
BELLEVUE WA
98005-3056
US

IV. Provider business mailing address

18505 SE NEWPORT WAY UNIT B109
ISSAQUAH WA
98027-9015
US

V. Phone/Fax

Practice location:
  • Phone: 971-801-2054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: