Provider Demographics
NPI:1144689159
Name:LANDAVERDE, JENNIFER (LMHCA, LMFTA, MHP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LANDAVERDE
Suffix:
Gender:F
Credentials:LMHCA, LMFTA, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4554 DELRIDGE WAY SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1327
Mailing Address - Country:US
Mailing Address - Phone:253-221-7461
Mailing Address - Fax:
Practice Address - Street 1:5031 UNIVERSITY WAY NE # 105
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4341
Practice Address - Country:US
Practice Address - Phone:206-427-0115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
WAMG60990301106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst