Jacqueline Kathleen Kosak

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MC60831021 Issued in WA

Practice address

2600 SW Holden St
Seattle, WA 98126-3505

Phone

(206) 933-7106

NPI assigned

Oct 29, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Liminal Terrestrial

  • Mental Health Counselor
  • Seattle, WA
  • NPI 1033863592
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540771200000",
    "number": "1891262861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 S MAIN ST UNIT C",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981442204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 SW HOLDEN ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981263505",
            "telephone_number": "206-933-7106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSAK",
        "first_name": "JACQUELINE",
        "middle_name": "KATHLEEN",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-29",
        "last_updated": "2018-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC60831021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca R Kornstedt, M.S.
• Konstantin Koro, M.D.
• Katrina Korreckt
• Ashley Kortman, MS
• Chantelle Korver, DAOM, LAC, EAMP
• Bradley William Kosel, PHARMD
• Kayla Marie Kosel, RPH
• Mekhala Koshy, MSW, LICSW
• David John Kosins, PH.D.
• Natalie Koskela-Staples, PHD

• Mental Health Counselor in Seattle, WA
• Providers in Seattle, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.