Healthcare Provider Details

I. General information

NPI: 1912801937
Provider Name (Legal Business Name): JESSIE LYNN GROENIGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 WESTLAKE AVE STE 100
SEATTLE WA
98121-2695
US

IV. Provider business mailing address

10336 W DEEP CANYON DR
STAR ID
83669-5354
US

V. Phone/Fax

Practice location:
  • Phone: 206-956-9570
  • Fax:
Mailing address:
  • Phone: 208-985-5319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: