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General NPI Number Information
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NPI Number | 1245765650
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Entity Type | Individual
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Provider Name | RENEE ST JACQUES PSY.D
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Gender | Female
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Dates
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Enumeration Date | 04/23/2017
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 4030 LAKE WASHINGTON BLVD NE STE 201
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City | KIRKLAND
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State | WA
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Zip | 98033-7870
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Country | US
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Telephone | 971-251-5513
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Fax |
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Provider Business Mailing Address
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Address Line | 4030 LAKE WASHINGTON BLVD NE STE 201
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City | KIRKLAND
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State | WA
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Zip | 98033-7870
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Country | US
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Telephone | 971-251-5513
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSYC.PY.60613458
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License Number State | WA
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