Healthcare Provider Details

I. General information

NPI: 1801392329
Provider Name (Legal Business Name): JENNIFER ANN HURLEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN SORENSON LICSW

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S 333RD ST STE 116
FEDERAL WAY WA
98003-7099
US

IV. Provider business mailing address

402 S 333RD ST STE 116
AUBURN WA
98003-7099
US

V. Phone/Fax

Practice location:
  • Phone: 206-499-6179
  • Fax:
Mailing address:
  • Phone: 206-499-6179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00009330
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: