Healthcare Provider Details

I. General information

NPI: 1649647561
Provider Name (Legal Business Name): JEDIDIAH SIMEON SAVARD PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 NW GILMAN BLVD STE. 2 #9141
ISSAQUAH WA
98027
US

IV. Provider business mailing address

PO BOX 1208
RAYMOND MS
39154-1208
US

V. Phone/Fax

Practice location:
  • Phone: 425-243-3665
  • Fax:
Mailing address:
  • Phone: 603-520-8107
  • Fax: 601-779-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number661253
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60921845
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: