Provider Demographics
NPI:1902394661
Name:COURTNEY-JACKSON, JENNIE N
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:N
Last Name:COURTNEY-JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 NE 197TH PL APT B
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1242
Mailing Address - Country:US
Mailing Address - Phone:206-226-8604
Mailing Address - Fax:
Practice Address - Street 1:18311 BOTHELL EVERETT HWY STE 180&260
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-5233
Practice Address - Country:US
Practice Address - Phone:206-437-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst