Provider Demographics
NPI:1033513106
Name:JANNACK, ANNA (BFA, MA, LMHC, ATR)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:JANNACK
Suffix:
Gender:F
Credentials:BFA, MA, LMHC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3258 CALIFORNIA AVE SW STE B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3358
Mailing Address - Country:US
Mailing Address - Phone:206-474-9708
Mailing Address - Fax:
Practice Address - Street 1:3258 CALIFORNIA AVE SW STE B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3358
Practice Address - Country:US
Practice Address - Phone:206-474-9708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60734918101Y00000X
WACG60506618390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor