Provider Demographics
NPI:1740178557
Name:EASTMAN, JENAE (MC)
Entity type:Individual
Prefix:
First Name:JENAE
Middle Name:
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 CATON WAY SW STE 201
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8201
Mailing Address - Country:US
Mailing Address - Phone:360-654-7398
Mailing Address - Fax:
Practice Address - Street 1:2024 CATON WAY SW STE 201
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8201
Practice Address - Country:US
Practice Address - Phone:360-654-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61626660101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC61626660OtherWASHINGTON DEPARTMENT OF HEALTH