Healthcare Provider Details

I. General information

NPI: 1508706599
Provider Name (Legal Business Name): LAUREN JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 W BELL ST STE B
SEQUIM WA
98382-2916
US

IV. Provider business mailing address

41 WILCOX LN
SEQUIM WA
98382-8905
US

V. Phone/Fax

Practice location:
  • Phone: 360-207-4345
  • Fax:
Mailing address:
  • Phone: 360-460-7128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: