Provider Demographics
NPI:1427265255
Name:ITSKOVICH, JENNIFER ANN (MSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:ITSKOVICH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10634 E RIVERSIDE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3758
Mailing Address - Country:US
Mailing Address - Phone:425-821-5021
Mailing Address - Fax:425-821-7968
Practice Address - Street 1:700 COMMERCE DR STE 255
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-5406
Practice Address - Country:US
Practice Address - Phone:651-714-3848
Practice Address - Fax:651-344-0820
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00009171101YM0800X
MN203681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health