MEDICARE: JEFFREY STOVER PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY00003255	WA

General Provider Information

NPI Number	:	1518044817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY STOVER PSYD

Provider Business Mailing Address
First Line	:	2099 N COLLINS BLVD
Second Line	:	SUITE 100
City	:	RICHARDSON
State	:	TX
Zip	:	75080-2698
Country	:	US
Telephone Number	:	972-437-4698
Fax Number	:	972-671-2087

Provider Business Practice Location Address
First Line	:	9706 4TH AVE NE
Second Line	:	SUITE 203
City	:	SEATTLE
State	:	WA
Zip	:	98115-2157
Country	:	US
Telephone Number	:	206-517-7697
Fax Number	:	206-729-7078

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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Directions to “ JEFFREY STOVER PSYD” Practice Location

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