Provider Demographics
NPI:1932316858
Name:JHUECK, DIANE A (MA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:A
Last Name:JHUECK
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:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-0283
Mailing Address - Country:US
Mailing Address - Phone:360-239-4564
Mailing Address - Fax:
Practice Address - Street 1:6442 CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-9698
Practice Address - Country:US
Practice Address - Phone:360-239-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00044328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health