Provider Demographics
NPI:1629450507
Name:CAGGIANO, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:CAGGIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31405 18TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5433
Mailing Address - Country:US
Mailing Address - Phone:253-681-6640
Mailing Address - Fax:253-681-6632
Practice Address - Street 1:31405 18TH AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:253-681-6640
Practice Address - Fax:253-681-6632
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health