Provider Demographics
NPI:1245431899
Name:RODRIGUEZ, JEANETTE (MFCC)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MFCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3532 NE 153RD ST APT 203
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7465
Mailing Address - Country:US
Mailing Address - Phone:206-310-7487
Mailing Address - Fax:
Practice Address - Street 1:3532 NE 153RD ST APT 203
Practice Address - Street 2:
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-7465
Practice Address - Country:US
Practice Address - Phone:206-310-7487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22448106H00000X
WA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist