Provider Demographics
NPI:1619501962
Name:CAITLIN JESSE, GRIEF PATHWAYS, PLLC
Entity Type:Organization
Organization Name:CAITLIN JESSE, GRIEF PATHWAYS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:JESSE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-454-9678
Mailing Address - Street 1:4326 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3324
Mailing Address - Country:US
Mailing Address - Phone:206-948-0774
Mailing Address - Fax:
Practice Address - Street 1:4860 RAINIER AVE S STE C
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-6305
Practice Address - Country:US
Practice Address - Phone:206-454-9678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1689208993OtherTYPE 1 INDIVIDUAL PROVIDER