Healthcare Provider Details

I. General information

NPI: 1225428352
Provider Name (Legal Business Name): JENNIFER WALTER LMHC, SUDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 90TH DR SE
LAKE STEVENS WA
98258-3788
US

IV. Provider business mailing address

5005 200TH ST SW STE B
LYNNWOOD WA
98036-6682
US

V. Phone/Fax

Practice location:
  • Phone: 360-481-2640
  • Fax:
Mailing address:
  • Phone: 360-481-2640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60159417
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: