| Doctor Name: | MS. JACQUELINE MARIE CONQUEST |
| NPI Number: | 1326333535 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA., LMHC., CCH |
| License Number: | LH 00006954 |
| Business Practice Address: | 21907 64th Ave W Ste 220 Mountlake Terrace, WA - 980436200 |
| Business Phone Number: | 2063306497 |
| Business Fax Number: | 4256409600 |
| Mailing Address: | 16520 72nd Ave Ne, KENMORE |
| State: | WA |
| Postal Code: | 98028 |
| Phone Number: | 2063306497 |
| Fax Number: | |
| NPI Enumeration Date: | 06/15/2011 |
| NPI Last Update Date: | 06/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LH 00006954 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |