Basic Information
| Provider Information | |||||||||
| NPI: | 1003075896 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECKWITH | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | DAVILA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DAVILA | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | ANNE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1600 E OLIVE ST | ||||||||
| Address2: | SOUND MENTAL HEALTH | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981222735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063022200 | ||||||||
| FaxNumber: | 2063022210 | ||||||||
| Practice Location | |||||||||
| Address1: | 14270 NE 21ST ST | ||||||||
| Address2: | SOUND MENTAL HEALTH - RAINBOW CREEK | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980073720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256535000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2008 | ||||||||
| LastUpdateDate: | 06/05/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | RC00058053 | WA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.