Provider Demographics
NPI:1851736318
Name:MANNING, JEANNIE ASHMORE (MA, LMHC, CDP)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:ASHMORE
Last Name:MANNING
Suffix:
Gender:F
Credentials:MA, LMHC, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19928 BOTHELL EVERETT HWY APT 817
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7194
Mailing Address - Country:US
Mailing Address - Phone:770-906-5866
Mailing Address - Fax:
Practice Address - Street 1:19110 BOTHELL WAY NE STE 206
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2970
Practice Address - Country:US
Practice Address - Phone:770-906-5866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60336441101YM0800X
WALH60523785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2043626Medicaid