Provider Demographics
NPI:1972717619
Name:LINDBERG, JENNIE A (MA, LMFT, CDP)
Entity type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:A
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:MA, LMFT, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 SUMMIT AVE
Mailing Address - Street 2:EVERGREEN MANOR
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3309
Mailing Address - Country:US
Mailing Address - Phone:425-258-2407
Mailing Address - Fax:425-339-2601
Practice Address - Street 1:2601 SUMMIT AVE
Practice Address - Street 2:EVERGREEN MANOR
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3309
Practice Address - Country:US
Practice Address - Phone:425-258-2407
Practice Address - Fax:425-339-2601
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001284101YA0400X
WALF00001190101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist