Provider Demographics
NPI:1477036739
Name:HIETT, JONATHAN JACOB
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:JACOB
Last Name:HIETT
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JONNY
Other - Middle Name:JACOB
Other - Last Name:HIETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4904 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1825
Mailing Address - Country:US
Mailing Address - Phone:303-862-0766
Mailing Address - Fax:
Practice Address - Street 1:101 ELLIOTT AVE W STE 500
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4292
Practice Address - Country:US
Practice Address - Phone:206-708-6432
Practice Address - Fax:206-323-2184
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61384297101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health