Provider Demographics
NPI:1750097887
Name:CARO, JENNY ROCIO
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:ROCIO
Last Name:CARO
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 1:9650 15TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2576
Mailing Address - Country:US
Mailing Address - Phone:062-965-1055
Mailing Address - Fax:206-965-1032
Practice Address - Street 1:9650 15TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2576
Practice Address - Country:US
Practice Address - Phone:206-965-1055
Practice Address - Fax:206-965-1032
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61352950101Y00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program