Individual
MS. JEANNE HEATHER WICOMB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
1601 114TH AVE SE, SUITE 180, BELLEVUE, WA 98004-6950
(425) 451-1134
(425) 451-8501
Mailing address
1601 114TH AVE SE, THE MOORE CENTER, SUITE 180, BELLEVUE, WA 98004-6950
(425) 451-1134
(425) 451-8501
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LF00001898
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W904633
CHAMPUS
WA
Enumeration date
04/04/2007
Last updated
07/08/2007
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