Provider Demographics
NPI:1801998117
Name:STAMM, JENNIFER (DCSW ACSW MSW LICSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:STAMM
Suffix:
Gender:F
Credentials:DCSW ACSW MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-3335
Mailing Address - Fax:206-764-0489
Practice Address - Street 1:2500 E. COLLEGE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5862
Practice Address - Country:US
Practice Address - Phone:360-428-8912
Practice Address - Fax:360-424-6288
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00004905101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health