Provider Demographics
NPI:1104446673
Name:PHINN, JADE (LSW)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:PHINN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-5102
Mailing Address - Country:US
Mailing Address - Phone:206-464-6454
Mailing Address - Fax:
Practice Address - Street 1:216 JAMES ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-5102
Practice Address - Country:US
Practice Address - Phone:206-464-6454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2024-03-19
Deactivation Date:2022-06-01
Deactivation Code:
Reactivation Date:2022-10-26
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009924850101Y00000X
WASC61521205101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor