Provider Demographics
NPI:1720555840
Name:MULVIHILL, JEANNETTE WYATT (MSW, LICSW, SUDP)
Entity type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:WYATT
Last Name:MULVIHILL
Suffix:
Gender:F
Credentials:MSW, LICSW, SUDP
Other - Prefix:MRS
Other - First Name:JEANNETTE
Other - Middle Name:
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, CDP
Mailing Address - Street 1:815 N STRATFORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1587
Mailing Address - Country:US
Mailing Address - Phone:206-588-6975
Mailing Address - Fax:
Practice Address - Street 1:15601 93RD CT NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-6810
Practice Address - Country:US
Practice Address - Phone:206-588-6975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60499386101YA0400X
WALW615033891041C0700X
WACG60901239101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical