Provider Demographics
NPI:1962593293
Name:WAREHAM, JENNIFER SUE (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:WAREHAM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SUE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:550 DEER HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-9201
Mailing Address - Country:US
Mailing Address - Phone:720-626-7293
Mailing Address - Fax:360-850-0237
Practice Address - Street 1:550 DEER HARBOR RD
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-9201
Practice Address - Country:US
Practice Address - Phone:720-626-7293
Practice Address - Fax:360-850-2037
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO770106H00000X
UT51363653902106H00000X
ID6229106H00000X
WA60642442106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist