Provider Demographics
NPI:1942428768
Name:VALENZUELA, JACQUELYN (MS)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17121 SE 270TH PL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5431
Mailing Address - Country:US
Mailing Address - Phone:253-638-9988
Mailing Address - Fax:253-638-7465
Practice Address - Street 1:17121 SE 270TH PL
Practice Address - Street 2:SUITE 205
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-5431
Practice Address - Country:US
Practice Address - Phone:253-638-9988
Practice Address - Fax:253-638-7465
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health