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General NPI Number Information
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NPI Number | 1477982791
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Entity Type | Individual
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Provider Name | STACY JORDAN CECCHET PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 1721 HEWITT AVE SUITE 416
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City | EVERETT
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State | WA
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Zip | 98201-3570
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Country | US
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Telephone | 425-789-1073
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13221
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City | EVERETT
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State | WA
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Zip | 98206-3221
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60401712
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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