Provider Demographics
NPI:1538975321
Name:O'FLAHERTY, JEANNE
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:O'FLAHERTY
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:LUKE
Other - Middle Name:
Other - Last Name:O'FLAHERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3928 S HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1923
Mailing Address - Country:US
Mailing Address - Phone:816-830-3299
Mailing Address - Fax:
Practice Address - Street 1:3928 S HUDSON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1923
Practice Address - Country:US
Practice Address - Phone:816-830-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61573720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health