Healthcare Provider Details

I. General information

NPI: 1205230935
Provider Name (Legal Business Name): IKRON GREATER SEATTLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 108TH AVE NE STE. 204
BELLEVUE WA
98004-7613
US

IV. Provider business mailing address

3805 108TH AVE NE STE. 204
BELLEVUE WA
98004-7613
US

V. Phone/Fax

Practice location:
  • Phone: 425-242-1713
  • Fax:
Mailing address:
  • Phone: 425-242-1713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number314
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number314
License Number StateWA

VIII. Authorized Official

Name: JENNIFER JEFFERIES
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, LMHC, MHP
Phone: 425-242-1713