Provider Demographics
NPI:1558480681
Name:REED, MARY JANE (CDP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:REED
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 LOPEZ DR
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9529
Mailing Address - Country:US
Mailing Address - Phone:360-933-1987
Mailing Address - Fax:
Practice Address - Street 1:2030 DIVISION ST
Practice Address - Street 2:B
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8014
Practice Address - Country:US
Practice Address - Phone:360-676-2020
Practice Address - Fax:360-734-2106
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005210101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)