Provider Demographics
NPI:1821543570
Name:JACQUIE GALLAWAY, LLC
Entity type:Organization
Organization Name:JACQUIE GALLAWAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GALLAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMHCA
Authorized Official - Phone:206-457-9291
Mailing Address - Street 1:200 1ST AVE W STE 400
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4219
Mailing Address - Country:US
Mailing Address - Phone:206-457-9291
Mailing Address - Fax:
Practice Address - Street 1:200 1ST AVE W STE 400
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4219
Practice Address - Country:US
Practice Address - Phone:206-457-9291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60301591251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health