Provider Demographics
NPI:1780822817
Name:SOPHER, JANA M (MA)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:M
Last Name:SOPHER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 MAIN ST
Mailing Address - Street 2:SUITE 115C
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3166
Mailing Address - Country:US
Mailing Address - Phone:206-218-8619
Mailing Address - Fax:
Practice Address - Street 1:406 MAIN ST
Practice Address - Street 2:SUITE 115C
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3166
Practice Address - Country:US
Practice Address - Phone:206-218-8619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC0048669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health