Healthcare Provider Details

I. General information

NPI: 1003075896
Provider Name (Legal Business Name): JENNIFER DAVILA BECKWITH RC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JENNIFER ANNE DAVILA

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14270 NE 21ST ST SOUND MENTAL HEALTH - RAINBOW CREEK
BELLEVUE WA
98007-3720
US

IV. Provider business mailing address

1600 E OLIVE ST SOUND MENTAL HEALTH
SEATTLE WA
98122-2735
US

V. Phone/Fax

Practice location:
  • Phone: 425-653-5000
  • Fax:
Mailing address:
  • Phone: 206-302-2200
  • Fax: 206-302-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRC00058053
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: