Provider Demographics
NPI:1083048532
Name:RICE, JANNAE ESTRADA (LMHC, CN, LMP,)
Entity Type:Individual
Prefix:
First Name:JANNAE
Middle Name:ESTRADA
Last Name:RICE
Suffix:
Gender:F
Credentials:LMHC, CN, LMP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16520 NORTH RD APT C203
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5961
Mailing Address - Country:US
Mailing Address - Phone:508-843-1880
Mailing Address - Fax:
Practice Address - Street 1:13128 TOTEM LAKE BLVD NE
Practice Address - Street 2:# 104
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2953
Practice Address - Country:US
Practice Address - Phone:508-843-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-02
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU 60300922133NN1002X
WALH60774623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education