Provider Demographics
NPI:1528390085
Name:SZARKA, JACKIE GRIMESEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:GRIMESEY
Last Name:SZARKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JACKIE
Other - Middle Name:LYNN
Other - Last Name:GRIMESEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:901 BOREN AVE
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3595
Mailing Address - Country:US
Mailing Address - Phone:425-829-6405
Mailing Address - Fax:
Practice Address - Street 1:901 BOREN AVE
Practice Address - Street 2:SUITE 1300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3595
Practice Address - Country:US
Practice Address - Phone:425-829-6405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60276365103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist