Healthcare Provider Details

I. General information

NPI: 1437694973
Provider Name (Legal Business Name): JESSICA ANN MCBRIDE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ANN BOYLE PHD

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 NE 87TH AVE
VANCOUVER WA
98664-1915
US

IV. Provider business mailing address

814 NE 87TH AVE
VANCOUVER WA
98664-1915
US

V. Phone/Fax

Practice location:
  • Phone: 360-910-1522
  • Fax: 360-326-1522
Mailing address:
  • Phone: 360-910-1522
  • Fax: 360-326-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60803946
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: