Provider Demographics
NPI:1427302496
Name:CRAIG, JEANNE ANNE (PHD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:ANNE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 1ST ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5415
Mailing Address - Country:US
Mailing Address - Phone:425-822-8159
Mailing Address - Fax:425-803-0143
Practice Address - Street 1:1118 1ST ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5415
Practice Address - Country:US
Practice Address - Phone:425-822-8159
Practice Address - Fax:425-803-0143
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005945101YM0800X
WA152573B103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool