Healthcare Provider Details

I. General information

NPI: 1518490812
Provider Name (Legal Business Name): JODIE CLARE FROMBACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 6TH AVE STE 100-5068
TACOMA WA
98405-3300
US

IV. Provider business mailing address

1712 6TH AVE STE 100-5068
TACOMA WA
98405-3300
US

V. Phone/Fax

Practice location:
  • Phone: 509-416-6065
  • Fax:
Mailing address:
  • Phone: 509-416-6065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60634436
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60704412
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: