Healthcare Provider Details

I. General information

NPI: 1174987465
Provider Name (Legal Business Name): JENNY COOKE MALSTROM LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY COOKE

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22525 MARINE VIEW DR S STE 200
DES MOINES WA
98198-6879
US

IV. Provider business mailing address

22525 MARINE VIEW DR S STE 200
DES MOINES WA
98198-6879
US

V. Phone/Fax

Practice location:
  • Phone: 206-705-3060
  • Fax:
Mailing address:
  • Phone: 206-705-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF61126655
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberTPMF502
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: