Provider Demographics
NPI:1588006340
Name:PEOT, JEWEL MARIE (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:MARIE
Last Name:PEOT
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13110 NE 177TH PL # 154
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-5740
Mailing Address - Country:US
Mailing Address - Phone:808-937-6134
Mailing Address - Fax:541-447-6694
Practice Address - Street 1:19900 174TH AVE NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-7012
Practice Address - Country:US
Practice Address - Phone:425-298-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR283234Medicaid