Healthcare Provider Details

I. General information

NPI: 1821898917
Provider Name (Legal Business Name): JENEVA H GRACE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 161ST AVE NE STE 202
REDMOND WA
98052-3858
US

IV. Provider business mailing address

25748 SE 40TH ST
SAMMAMISH WA
98029-7760
US

V. Phone/Fax

Practice location:
  • Phone: 425-979-4339
  • Fax:
Mailing address:
  • Phone: 206-841-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61652043
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: