Provider Demographics
NPI:1023501178
Name:O'CONNELL, JEANINE
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19515 N CREEK PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-8200
Mailing Address - Country:US
Mailing Address - Phone:425-598-8800
Mailing Address - Fax:
Practice Address - Street 1:19515 N CREEK PKWY STE 208
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-8200
Practice Address - Country:US
Practice Address - Phone:425-598-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOCONNJM437LZOtherWA LICENSE