Basic Information
| Provider Information | |||||||||
| NPI: | 1346850526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLONDHEIM | ||||||||
| FirstName: | JAKE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1811 N NORTHGATE WAY APT 306D | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981332814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603058005 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 RAINIER AVE S | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981442839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064703856 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2020 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.