Provider Demographics
NPI:1588263032
Name:JEWETT, MARK ALAN (MSW, CADC-II, CDP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:JEWETT
Suffix:
Gender:M
Credentials:MSW, CADC-II, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 208TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-6936
Mailing Address - Country:US
Mailing Address - Phone:425-761-7321
Mailing Address - Fax:
Practice Address - Street 1:528 208TH AVE NE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-6936
Practice Address - Country:US
Practice Address - Phone:425-761-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA8499705101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)