Basic Information
Provider Information
NPI: 1447341474
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WHETSTONE
FirstName: JANE
MiddleName: MARIE
NamePrefix: MRS.
NameSuffix:  
Credential: BA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1660 S COLUMBIAN WAY MS S116MHC
Address2: SEATTLE VA
City: SEATTLE
State: WA
PostalCode: 981081597
CountryCode: US
TelephoneNumber: 2067642007
FaxNumber: 2067642572
Practice Location
Address1: 1660 S COLUMBIAN WAY MS S116MHC
Address2: SEATTLE VA
City: SEATTLE
State: WA
PostalCode: 981081597
CountryCode: US
TelephoneNumber: 2067642007
FaxNumber: 2067642572
Other Information
ProviderEnumerationDate: 09/27/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XRC00008517WAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


Home