Individual ProviderJennifer LakeCounselorBehavioral Health & Social Service ProvidersPractice Address11335 NE 122nd Way Ste 105, Kirkland, WA 98034-6933(662) 571-2025PECOS EnrollmentBased on the most recent information from CMS, provider Jennifer Lake does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1164079968Provider TypeIndividualFull NameLake, JenniferGenderFemaleSole ProprietorYesEnumeration Date8/26/2019Last Updated8/26/2019Contact InformationPractice LocationPractice Address11335 NE 122nd Way Ste 105, Kirkland, WA 98034-6933Phone(662) 571-2025FaxUnlisted FaxMailing LocationMailing Address1286 Cross Creek Blvd, Hernando, MS 38632Phone(662) 571-2025FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseLH60971860Washington