Provider Demographics
NPI:1073087052
Name:COONEY, JENNIFER M (MS, CC, RBT, CBT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:COONEY
Suffix:
Gender:F
Credentials:MS, CC, RBT, CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 LECKLER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98611-9264
Mailing Address - Country:US
Mailing Address - Phone:360-430-1594
Mailing Address - Fax:
Practice Address - Street 1:498 LECKLER CREEK RD
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:WA
Practice Address - Zip Code:98611-9264
Practice Address - Country:US
Practice Address - Phone:360-430-1594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL61207828101Y00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician