Healthcare Provider Details

I. General information

NPI: 1164355251
Provider Name (Legal Business Name): JENNA LOUISE MEYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 BOTHELL EVERETT HWY
MILL CREEK WA
98012-1742
US

IV. Provider business mailing address

7718 129TH DR SE
SNOHOMISH WA
98290-6234
US

V. Phone/Fax

Practice location:
  • Phone: 415-860-4739
  • Fax:
Mailing address:
  • Phone: 415-860-4739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG.70133134
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: