Provider Demographics
NPI:1568844926
Name:KOLLASCH, JENNIFER (MA COUNSELING)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KOLLASCH
Suffix:
Gender:F
Credentials:MA COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1513
Mailing Address - Country:US
Mailing Address - Phone:206-434-5524
Mailing Address - Fax:
Practice Address - Street 1:5416 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1513
Practice Address - Country:US
Practice Address - Phone:206-434-5524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60793224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health