Provider Demographics
NPI:1861282568
Name:MITCHELL, JENNA CATHERINE
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:CATHERINE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12945 NE 203RD ST
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-5760
Mailing Address - Country:US
Mailing Address - Phone:903-691-4491
Mailing Address - Fax:
Practice Address - Street 1:11410 NE 122ND WAY STE 100
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6927
Practice Address - Country:US
Practice Address - Phone:425-650-4005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician