Healthcare Provider Details

I. General information

NPI: 1104481506
Provider Name (Legal Business Name): JADE WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9215 S 198TH ST
RENTON WA
98055-4111
US

IV. Provider business mailing address

1101 ANDOVER PARK W STE 107
TUKWILA WA
98188-3911
US

V. Phone/Fax

Practice location:
  • Phone: 425-691-6936
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: