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General NPI Number Information
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NPI Number | 1780352831
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Entity Type | Individual
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Provider Name | JAILENE IGLESIAS
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Gender | Female
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 100 N HOWARD ST, STE W 100 N HOWARD ST, STE W
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City | SPOKANE
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State | WA
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Zip | 99201
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Country | US
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Telephone | 206-702-8117
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 AURORA AVE N APT S106
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City | SEATTLE
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State | WA
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Zip | 98103-7393
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Country | US
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Telephone | 612-814-5495
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC61329146
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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