Jennifer Karynne Dedeaux
Individual provider Active NPI Counselor · Spanaway, WA
NPI 1902463045 · NPPES record last updated May 23, 2019
Key facts
- NPI
- 1902463045
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 201 160TH St S
Spanaway, WA 98387-8508 - Phone
- (253) 396-5015
- NPI assigned
- May 23, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
201 160TH St S
Spanaway, WA 98387-8508
Mailing address
201 160TH St S
Spanaway, WA 98387-8508
Phone (253) 396-5015
Other providers in Spanaway, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.