Provider Demographics
NPI:1477161305
Name:MANLOWE, JENNIFER LEWIS (LMFTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEWIS
Last Name:MANLOWE
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HIGH SCHOOL RD NE APT 116
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3670
Mailing Address - Country:US
Mailing Address - Phone:206-617-8832
Mailing Address - Fax:
Practice Address - Street 1:9633 LEVIN RD NW STE 100
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8132
Practice Address - Country:US
Practice Address - Phone:360-698-5883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61072842106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty