Provider Demographics
NPI:1427446251
Name:BLACKBOURN, JAYMEE
Entity type:Individual
Prefix:
First Name:JAYMEE
Middle Name:
Last Name:BLACKBOURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAYMEE
Other - Middle Name:
Other - Last Name:GREGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 LINCOLN ST FL 24
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-2901
Mailing Address - Country:US
Mailing Address - Phone:617-454-4672
Mailing Address - Fax:
Practice Address - Street 1:5006 CENTER ST STE R
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2314
Practice Address - Country:US
Practice Address - Phone:253-275-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61091071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health