Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY60129683 | WA |
N | 103T00000X | Psychologist | PY60129683 | WA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY60129683 | WA |
Y | 103G00000X | Clinical Psychologist | PY60129683 | WA |
Y | 103TC0700X | Clinical Psychologist | PY60129683 | WA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY60129683 | WA |
NPI | 1104994888 |
---|---|
Provider Name | Ms. Jennifer Rose Tininenko |
First Address | Seattle, WA 98101-3132 |
Second Address | Seattle, WA 98101-3132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 01/07/2010 |