Healthcare Provider Details

I. General information

NPI: 1679257083
Provider Name (Legal Business Name): MRS. JODI ESCARENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 DELRIDGE WAY SW
SEATTLE WA
98106-1379
US

IV. Provider business mailing address

12406 14TH AVE SW
BURIEN WA
98146-2617
US

V. Phone/Fax

Practice location:
  • Phone: 206-937-7680
  • Fax:
Mailing address:
  • Phone: 206-293-0482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: