Provider Demographics
NPI:1215369871
Name:WUEST, JOLENE JANEL (MS LMHC, CMHS)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:JANEL
Last Name:WUEST
Suffix:
Gender:F
Credentials:MS LMHC, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1797 CADBOROUGH LN
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8796
Mailing Address - Country:US
Mailing Address - Phone:253-306-5103
Mailing Address - Fax:
Practice Address - Street 1:8312 CUSTER RD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2526
Practice Address - Country:US
Practice Address - Phone:253-306-5103
Practice Address - Fax:253-306-5103
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60558824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1215369871Medicaid