Healthcare Provider Details

I. General information

NPI: 1780886341
Provider Name (Legal Business Name): FOR A CHILD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5224 WILSON AVE S SUITE 101A
SEATTLE WA
98118-2587
US

IV. Provider business mailing address

5224 WILSON AVE S SUITE 101A
SEATTLE WA
98118-2587
US

V. Phone/Fax

Practice location:
  • Phone: 206-725-1820
  • Fax: 206-725-1890
Mailing address:
  • Phone: 206-725-1820
  • Fax: 206-725-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY00002482
License Number StateWA

VIII. Authorized Official

Name: DR. JANINE JONES
Title or Position: OWNER
Credential: PHD
Phone: 206-725-1820