Healthcare Provider Details

I. General information

NPI: 1972069029
Provider Name (Legal Business Name): JENNIFER L BAYER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 10TH ST STE 203
BELLINGHAM WA
98225-7053
US

IV. Provider business mailing address

1140 10TH ST STE 203
BELLINGHAM WA
98225-7053
US

V. Phone/Fax

Practice location:
  • Phone: 360-319-9930
  • Fax:
Mailing address:
  • Phone: 360-319-9930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU60176199
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY60902082
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: