Provider Demographics
NPI:1346914140
Name:BAGGE, JODI RENAE (MA, LMHCA)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:RENAE
Last Name:BAGGE
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16202 11TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-6342
Mailing Address - Country:US
Mailing Address - Phone:206-963-9607
Mailing Address - Fax:
Practice Address - Street 1:1900 NW DOCK PL STE 3
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4846
Practice Address - Country:US
Practice Address - Phone:206-274-5889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61165255101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health