Healthcare Provider Details

I. General information

NPI: 1881906444
Provider Name (Legal Business Name): JENNIFER A PALERMO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2010
Last Update Date: 07/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10564 5TH AVE NE STE 201
SEATTLE WA
98125-7200
US

IV. Provider business mailing address

10564 5TH AVE NE STE 201
SEATTLE WA
98125-7200
US

V. Phone/Fax

Practice location:
  • Phone: 206-617-9064
  • Fax: 206-364-2664
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 60058557
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: