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General NPI Number Information
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NPI Number | 1467935890
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Entity Type | Individual
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Provider Name | DIANAH LEIGH JACKSON LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 755 WINSLOW WAY E SUITE 206
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110
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Country | US
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Telephone | 206-953-2810
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Fax |
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Provider Business Mailing Address
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Address Line | 5511 RAGAN LN NE
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City | POULSBO
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State | WA
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Zip | 98370-8810
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Country | US
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Telephone | 206-953-2810
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 60872112
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License Number State | WA
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