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General NPI Number Information
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NPI Number | 1457751240
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Entity Type | Organization
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Legal Business Name | DR JENNIFER BEARSE PSYD LLC
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 800 OFFICERS ROW STE D
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City | VANCOUVER
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State | WA
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Zip | 98661-3847
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Country | US
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Telephone | 360-603-9443
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Fax | 360-603-9442
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Provider Business Mailing Address
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Address Line | PO BOX 61809
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City | VANCOUVER
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State | WA
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Zip | 98666-1809
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Country | US
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Telephone | 360-603-9443
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Fax | 360-603-9442
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Authorized Official
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Title or Position | PRESIDENT, OWNER
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Name | DR. JENNIFER LYNN BEARSE
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Credential | PSYD
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Telephone | 360-603-9443
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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 | PY60463236
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License Number State | WA
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