Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | CG60668080 | WA |
NPI | 1003385436 |
---|---|
Provider Name | Jenna Anne Heil |
First Address | Port Townsend, WA 98368-0565 |
Second Address | Port Townsend, WA 98368-2273 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2018 |
Last Update Date | 17/09/2019 |