Provider Demographics
NPI:1972217347
Name:MARLOW, JAYMIE MICHELLE (CB61368481)
Entity Type:Individual
Prefix:
First Name:JAYMIE
Middle Name:MICHELLE
Last Name:MARLOW
Suffix:
Gender:F
Credentials:CB61368481
Other - Prefix:
Other - First Name:DICE
Other - Middle Name:EIRA
Other - Last Name:MARLOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CB61368481
Mailing Address - Street 1:5870 BRASCH RD SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-1119
Mailing Address - Country:US
Mailing Address - Phone:737-242-6662
Mailing Address - Fax:
Practice Address - Street 1:4301 S PINE ST STE 505
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7208
Practice Address - Country:US
Practice Address - Phone:253-671-9909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61368481106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician