Healthcare Provider Details

I. General information

NPI: 1417829490
Provider Name (Legal Business Name): JESSICA MCNEELY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18912 N CREEK PKWY
BOTHELL WA
98011-8016
US

IV. Provider business mailing address

322 NE 158TH ST
SHORELINE WA
98155-5722
US

V. Phone/Fax

Practice location:
  • Phone: 425-666-2094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.61670869
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: