Provider Demographics
NPI:1215458203
Name:DEAN, GINA JAEGER (MA, MHP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:JAEGER
Last Name:DEAN
Suffix:
Gender:
Credentials:MA, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:EAST OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98540-0967
Mailing Address - Country:US
Mailing Address - Phone:360-970-8981
Mailing Address - Fax:
Practice Address - Street 1:3859 MARTIN WAY E STE 102
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5268
Practice Address - Country:US
Practice Address - Phone:360-704-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60653739101YM0800X
WAMG60652933106H00000X
WALH61079361101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist