Provider Demographics
NPI:1326419466
Name:JENNIFER CROKE PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:JENNIFER CROKE PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CROKE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:917-975-7712
Mailing Address - Street 1:5006 VARCO RD NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1806
Mailing Address - Country:US
Mailing Address - Phone:917-975-7712
Mailing Address - Fax:253-235-5236
Practice Address - Street 1:5120 VARCO RD NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1808
Practice Address - Country:US
Practice Address - Phone:917-975-7712
Practice Address - Fax:253-235-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000096851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty