Provider Demographics
NPI:1114498755
Name:MCMILLAN, JENNI ANNE (SUDPT, PEER)
Entity Type:Individual
Prefix:
First Name:JENNI
Middle Name:ANNE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:SUDPT, PEER
Other - Prefix:MRS
Other - First Name:JENNI
Other - Middle Name:ANNE
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CO-60788153
Mailing Address - Street 1:1305 TACOMA AVE S STE 305
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-1903
Mailing Address - Country:US
Mailing Address - Phone:253-396-5000
Mailing Address - Fax:
Practice Address - Street 1:1305 TACOMA AVE S STE 305
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1903
Practice Address - Country:US
Practice Address - Phone:253-396-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program