Provider Demographics
NPI:1386074003
Name:CHAMBERLAIN, JESSICA (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 S 2ND ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2017
Mailing Address - Country:US
Mailing Address - Phone:425-203-7200
Mailing Address - Fax:
Practice Address - Street 1:419 S 2ND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2017
Practice Address - Country:US
Practice Address - Phone:425-203-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0130901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical