Provider Demographics
NPI:1295911766
Name:HIGGINS, JACQUELIN MICHELLE (MS)
Entity type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:MICHELLE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JACQUELIN
Other - Middle Name:MICHELLE
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 E OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2735
Mailing Address - Country:US
Mailing Address - Phone:206-302-2200
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:4238 AUBURN WAY N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002
Practice Address - Country:US
Practice Address - Phone:253-876-7600
Practice Address - Fax:253-876-7610
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00058273101YP2500X
WALH60160343101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional