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General NPI Number Information
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NPI Number | 1245457316
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Entity Type | Individual
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Provider Name | JENNY LAVERDURE PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 9600 VETERANS DR SW
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City | TACOMA
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State | WA
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Zip | 98493-3307
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Country | US
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Telephone | 800-329-8387
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Fax |
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Provider Business Mailing Address
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Address Line | 9600 VETERANS DR SW
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City | TACOMA
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State | WA
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Zip | 98493-8896
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY.0006638
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License Number State | CO
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