Healthcare Provider Details

I. General information

NPI: 1609796283
Provider Name (Legal Business Name): JORDYN D LAFRENIERE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25423 98TH AVE S APT H103
KENT WA
98030-6102
US

IV. Provider business mailing address

25423 98TH AVE S APT H103
KENT WA
98030-6102
US

V. Phone/Fax

Practice location:
  • Phone: 206-909-4994
  • Fax:
Mailing address:
  • Phone: 206-909-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberSWI.LW.61151839
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: