Healthcare Provider Details

I. General information

NPI: 1124325386
Provider Name (Legal Business Name): JANEL MIODUUSZEWSKI M.A., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E. MADISON ST. #202
SEATTLE WA
98112
US

IV. Provider business mailing address

8821 12TH AVE SW
SEATTLE WA
98106-2436
US

V. Phone/Fax

Practice location:
  • Phone: 206-719-9117
  • Fax:
Mailing address:
  • Phone: 206-719-9117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH 00011255
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: