Healthcare Provider Details

I. General information

NPI: 1750546776
Provider Name (Legal Business Name): JEANNINE MAREE VINSON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 AIRPORT RD STE 200
EVERETT WA
98204-8711
US

IV. Provider business mailing address

11400 AIRPORT RD STE 200
EVERETT WA
98204-8711
US

V. Phone/Fax

Practice location:
  • Phone: 763-330-5254
  • Fax: 877-324-0284
Mailing address:
  • Phone: 763-330-5254
  • Fax: 877-324-0284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60303034
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: