Healthcare Provider Details

I. General information

NPI: 1548173982
Provider Name (Legal Business Name): RYAN VINSON-JACOBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RYAN ROSE RUBYTHROAT VINSON-JACOBS

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 RAINIER AVE S
SEATTLE WA
98118-1656
US

IV. Provider business mailing address

530 SMITHERS AVE S
RENTON WA
98057-2509
US

V. Phone/Fax

Practice location:
  • Phone: 206-660-4396
  • Fax:
Mailing address:
  • Phone: 509-906-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTA.MG.70177396
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: