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General NPI Number Information
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NPI Number | 1487933040
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Entity Type | Individual
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Provider Name | JENNIFER L BEARSE PSYD
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Gender | Female
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Dates
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Enumeration Date | 08/12/2011
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Last Update Date | 02/02/2025
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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 |
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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 | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | PY60463236
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2527
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License Number State | OR
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Taxonomy #3
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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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