Healthcare Provider Details

I. General information

NPI: 1275178022
Provider Name (Legal Business Name): JENNIFER HOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 NW CANAL ST STE 200
SEATTLE WA
98107-4970
US

IV. Provider business mailing address

126 NW CANAL ST STE 200
SEATTLE WA
98107-4970
US

V. Phone/Fax

Practice location:
  • Phone: 206-486-1500
  • Fax: 206-775-7215
Mailing address:
  • Phone: 206-486-1500
  • Fax: 206-775-7215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61076307
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60755695
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: