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General NPI Number Information
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NPI Number | 1396183406
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Entity Type | Individual
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Provider Name | JESSICA DAWN SVEDBERG GROUT LMFTA
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Gender | Female
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 601 VALLEY AVE NE SUITE B
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City | PUYALLUP
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State | WA
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Zip | 98372-2530
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Country | US
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Telephone | 253-343-2360
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Fax |
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Provider Business Mailing Address
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Address Line | 601 VALLEY AVE NE SUITE B
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City | PUYALLUP
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State | WA
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Zip | 98372-2530
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Country | US
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Telephone | 253-343-2360
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF60535996
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License Number State | WA
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