Provider Demographics
NPI:1467852194
Name:KING, JANE
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:KING
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 1:105 NW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-3138
Mailing Address - Country:US
Mailing Address - Phone:360-678-5555
Mailing Address - Fax:360-678-3636
Practice Address - Street 1:105 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3138
Practice Address - Country:US
Practice Address - Phone:360-678-5555
Practice Address - Fax:360-678-3636
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool