Individual
KIANDRA LISARAY JACOBSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
314 NE THORNTON PL, SEATTLE, WA 98125-9000
(206) 528-8000
Mailing address
5505 BROOKLYN AVE NE, SEATTLE, WA 98105-3517
(206) 356-8766
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW60171261
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1041C0700X
TAXONOMY CODE
WA
Enumeration date
08/03/2016
Last updated
08/03/2016
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