Healthcare Provider Details

I. General information

NPI: 1952226318
Provider Name (Legal Business Name): JORDYNN MACKENZIE MIDKIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

10227 20TH ST SE UNIT A301
LAKE STEVENS WA
98258-4790
US

IV. Provider business mailing address

320 150TH ST SE
LYNNWOOD WA
98087-6733
US

V. Phone/Fax

Practice location:
  • Phone: 206-321-7115
  • Fax:
Mailing address:
  • Phone: 206-321-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number61392315
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number61516979
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: