Healthcare Provider Details

I. General information

NPI: 1780097410
Provider Name (Legal Business Name): JESSE ELYSE CHASE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSE ELYSE BURRELL

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 MINOR AVE STE 400
SEATTLE WA
98101-2402
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-2961
  • Fax: 206-710-9013
Mailing address:
  • Phone: 206-320-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY61310099
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: