Provider Demographics
NPI:1932889821
Name:SCHULENBERG, JODIE (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:SCHULENBERG
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12525 58TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-6959
Mailing Address - Country:US
Mailing Address - Phone:425-409-7072
Mailing Address - Fax:
Practice Address - Street 1:10634 E RIVERSIDE DR STE 100
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3751
Practice Address - Country:US
Practice Address - Phone:425-869-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61447419101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health