Provider Demographics
NPI:1376275750
Name:O'BRIEN, JENIFER R (MS)
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:R
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5744 TWIN MAPLE LN NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2431
Mailing Address - Country:US
Mailing Address - Phone:206-200-6795
Mailing Address - Fax:
Practice Address - Street 1:5744 TWIN MAPLE LN NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2431
Practice Address - Country:US
Practice Address - Phone:206-200-6795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty