Provider Demographics
NPI:1245740612
Name:ST JEAN, BILLIE JO (MSW)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:JO
Last Name:ST JEAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:JO
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9633 LEVIN RD NW STE 3
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8131
Mailing Address - Country:US
Mailing Address - Phone:360-377-8200
Mailing Address - Fax:360-377-6956
Practice Address - Street 1:9633 LEVIN RD NW STE 3
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8131
Practice Address - Country:US
Practice Address - Phone:360-377-8200
Practice Address - Fax:360-377-6956
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60809394101YA0400X
WA101YM0800X
WALW610993071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2099484Medicaid