Provider Demographics
NPI:1144969411
Name:BATEMAN, JENNIFER RENEE (CP60601437)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RENEE
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:CP60601437
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:RENEE
Other - Last Name:MCNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CP60601437
Mailing Address - Street 1:10828 GRAVELLY LAKE DR SW STE 106
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1300
Mailing Address - Country:US
Mailing Address - Phone:253-304-8572
Mailing Address - Fax:
Practice Address - Street 1:10828 GRAVELLY LAKE DR SW STE 106
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1300
Practice Address - Country:US
Practice Address - Phone:253-300-0537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP6061437101Y00000X
WACP60601437101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2286492Medicaid