Provider Demographics
NPI:1417245234
Name:EDWARDS, JENNIFER WENDT (MA,LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WENDT
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16710 SMOKEY POINT BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8435
Mailing Address - Country:US
Mailing Address - Phone:360-363-4234
Mailing Address - Fax:360-363-4235
Practice Address - Street 1:16710 SMOKEY POINT BLVD STE 402
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8435
Practice Address - Country:US
Practice Address - Phone:360-363-4234
Practice Address - Fax:360-363-4235
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60717278101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2066179Medicaid