Healthcare Provider Details

I. General information

NPI: 1073214433
Provider Name (Legal Business Name): KRISTIN CHERRY JACKSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 DEXTER AVE N STE 1C
SEATTLE WA
98109-6202
US

IV. Provider business mailing address

1607 DEXTER AVE N STE 1C
SEATTLE WA
98109-6202
US

V. Phone/Fax

Practice location:
  • Phone: 425-405-5169
  • Fax:
Mailing address:
  • Phone: 206-351-3199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF70014165
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: