Provider Demographics
NPI:1003403395
Name:KRAEMER, JEANETTE M (LICSW)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:M
Last Name:KRAEMER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 112TH ST SW APT B215
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-7868
Mailing Address - Country:US
Mailing Address - Phone:425-534-0947
Mailing Address - Fax:
Practice Address - Street 1:7522 221ST PL SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8029
Practice Address - Country:US
Practice Address - Phone:425-775-4059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WA615336431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor