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General NPI Number Information
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NPI Number | 1386398816
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Entity Type | Organization
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Legal Business Name | JENNIFER GROSS, PSYD, INC
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 805 164TH ST SE STE 101
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City | MILL CREEK
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State | WA
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Zip | 98012-6316
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Country | US
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Telephone | 206-300-6644
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Fax | 425-357-0924
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Provider Business Mailing Address
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Address Line | 805 164TH ST SE STE 101
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City | MILL CREEK
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State | WA
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Zip | 98012-6316
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Country | US
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Telephone | 206-300-6644
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Fax | 425-357-0924
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JENNIFER GROSS
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Credential | PSYD
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Telephone | 206-300-6644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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