Provider Demographics
NPI:1215526157
Name:KAISER, JACKIE MARIE (CNA)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:MARIE
Last Name:KAISER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:MARIE
Other - Last Name:WAHLQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:5811 FRANCES AVE NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1428
Mailing Address - Country:US
Mailing Address - Phone:253-878-4030
Mailing Address - Fax:
Practice Address - Street 1:5811 FRANCES AVE NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1428
Practice Address - Country:US
Practice Address - Phone:253-878-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor