Provider Demographics
NPI:1033850771
Name:MCCONNELL, JAMIE BRUBAKER (MHP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:BRUBAKER
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 OLYMPIC BLVD W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-7538
Mailing Address - Country:US
Mailing Address - Phone:206-979-4421
Mailing Address - Fax:
Practice Address - Street 1:4215 OLYMPIC BLVD W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-7538
Practice Address - Country:US
Practice Address - Phone:206-979-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC607774911041C0700X
WALW614536271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW61453627OtherDEPARTMENT OF HEALTH