Provider Demographics
NPI:1831746684
Name:RUDDELL, JAMEE MARIE (LICSW, LMHC)
Entity type:Individual
Prefix:
First Name:JAMEE
Middle Name:MARIE
Last Name:RUDDELL
Suffix:
Gender:
Credentials:LICSW, LMHC
Other - Prefix:
Other - First Name:JAMEE
Other - Middle Name:MARIE
Other - Last Name:HOMUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16701 SE MCGILLIVRAY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-3485
Mailing Address - Country:US
Mailing Address - Phone:360-622-1010
Mailing Address - Fax:
Practice Address - Street 1:16701 SE MCGILLIVRAY BLVD STE 120
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-3485
Practice Address - Country:US
Practice Address - Phone:360-622-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61447666101YM0800X
WALW615022721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health