Healthcare Provider Details

I. General information

NPI: 1902545734
Provider Name (Legal Business Name): KATIE LYNN JENDREY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE LYNN JENDREY

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 3RD AVE
SEATTLE WA
98121-2385
US

IV. Provider business mailing address

2817 NW 85TH ST
SEATTLE WA
98117-3834
US

V. Phone/Fax

Practice location:
  • Phone: 206-432-3574
  • Fax:
Mailing address:
  • Phone: 253-970-7037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: