Provider Demographics
NPI:1508151044
Name:BAKER, JENNIFER JANELL (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JANELL
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:JANELL
Other - Last Name:MELBYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:700 FRONT ST S UNIT B209
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-4222
Mailing Address - Country:US
Mailing Address - Phone:509-750-8469
Mailing Address - Fax:
Practice Address - Street 1:2142 10TH AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-2845
Practice Address - Country:US
Practice Address - Phone:206-298-9647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60224257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health