Provider Demographics
NPI:1942747878
Name:SELF, JEN M REICHENBACH (PHD LICSW)
Entity Type:Individual
Prefix:DR
First Name:JEN
Middle Name:M REICHENBACH
Last Name:SELF
Suffix:
Gender:F
Credentials:PHD LICSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:SELF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD LICSW
Mailing Address - Street 1:8856 13TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2439
Mailing Address - Country:US
Mailing Address - Phone:206-949-8921
Mailing Address - Fax:
Practice Address - Street 1:8856 13TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2439
Practice Address - Country:US
Practice Address - Phone:206-949-8921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601712671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical