Provider Demographics
NPI:1982023446
Name:DELISLE, JACQUELINE MARIE (LMFT, MHP, CMHS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARIE
Last Name:DELISLE
Suffix:
Gender:F
Credentials:LMFT, MHP, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 WELLS AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2161
Mailing Address - Country:US
Mailing Address - Phone:206-794-8109
Mailing Address - Fax:425-226-6153
Practice Address - Street 1:221 WELLS AVE S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2161
Practice Address - Country:US
Practice Address - Phone:206-794-8109
Practice Address - Fax:425-226-6153
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60651912106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist