Provider Demographics
NPI:1720338957
Name:PATTERSON, JENNA LAURIZE (CDP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LAURIZE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 BENDIGO BLVD N
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-8945
Mailing Address - Country:US
Mailing Address - Phone:425-209-8216
Mailing Address - Fax:425-671-6198
Practice Address - Street 1:1309 BENDIGO BLVD N
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8945
Practice Address - Country:US
Practice Address - Phone:425-209-8216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60296823101YA0400X
WAMG60603744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)