Provider Demographics
NPI:1154575611
Name:PAIK, JEANNE (LF)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:
Last Name:PAIK
Suffix:
Gender:F
Credentials:LF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 NW 54TH ST STE 378
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3575
Mailing Address - Country:US
Mailing Address - Phone:206-657-6125
Mailing Address - Fax:
Practice Address - Street 1:1417 NW 54TH ST STE 378
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3575
Practice Address - Country:US
Practice Address - Phone:206-657-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60231152106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALF60231152OtherLICENSE