Healthcare Provider Details

I. General information

NPI: 1467118828
Provider Name (Legal Business Name): JENNIFER KLAHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 BOGACHIEL WAY
FORKS WA
98331-9120
US

IV. Provider business mailing address

530 BOGACHIEL WAY
FORKS WA
98331-9120
US

V. Phone/Fax

Practice location:
  • Phone: 360-374-5011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70134615
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: