Healthcare Provider Details

I. General information

NPI: 1295106300
Provider Name (Legal Business Name): JENNIFER KRISTINE CASTANETO CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 15TH AVE S STE 1L
SEATTLE WA
98108-2866
US

IV. Provider business mailing address

5333 15TH AVE S STE 1L
SEATTLE WA
98108-2866
US

V. Phone/Fax

Practice location:
  • Phone: 253-778-8085
  • Fax:
Mailing address:
  • Phone: 253-262-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP 00001359
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: