Provider Demographics
NPI:1134267073
Name:HU, JEANNIE C (MD)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:C
Last Name:HU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5859 NE 8TH ST
Mailing Address - Street 2:NONE
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4422
Mailing Address - Country:US
Mailing Address - Phone:425-207-3798
Mailing Address - Fax:
Practice Address - Street 1:912 N 1ST ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:425-207-3798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000446602084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2042093Medicaid