Provider Demographics
NPI:1750971693
Name:BROSSEAU-JENSEN, JENNIFER (MA CMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BROSSEAU-JENSEN
Suffix:
Gender:F
Credentials:MA CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24041 NE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-5467
Mailing Address - Country:US
Mailing Address - Phone:425-232-7511
Mailing Address - Fax:
Practice Address - Street 1:722 AVENUE D STE 1
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2365
Practice Address - Country:US
Practice Address - Phone:425-232-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61088227101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor