Healthcare Provider Details

I. General information

NPI: 1093187726
Provider Name (Legal Business Name): KAYLEIGH JAMISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 YESLER WAY CCAP
SEATTLE WA
98104
US

IV. Provider business mailing address

1600 E OLIVE ST. SOUND MENTAL HEALTH
SEATTLE WA
98122
US

V. Phone/Fax

Practice location:
  • Phone: 206-302-2820
  • Fax:
Mailing address:
  • Phone: 206-302-2200
  • Fax: 206-302-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCO60749256
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: