Basic Information
| Provider Information | |||||||||
| NPI: | 1215288956 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAWORSKI | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | KAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34703 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067643335 | ||||||||
| FaxNumber: | 2067648005 | ||||||||
| Practice Location | |||||||||
| Address1: | 669 WOODLAND SQUARE LOOP SE | ||||||||
| Address2: | |||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985031038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603594880 | ||||||||
| FaxNumber: | 3603594881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2012 | ||||||||
| LastUpdateDate: | 09/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MG60250522 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.