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General NPI Number Information
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NPI Number | 1720050974
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Entity Type | Individual
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Provider Name | YAMILE JANA CLINICAL PSYCH
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Gender | Female
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 20455 1ST AVE NE APT H103
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City | POULSBO
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State | WA
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Zip | 98370-9319
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Country | US
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Telephone | 443-370-2888
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Fax |
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Provider Business Mailing Address
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Address Line | 20455 1ST AVE NE APT H103
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City | POULSBO
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State | WA
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Zip | 98370-9319
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Country | US
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Telephone | 443-370-2888
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1306
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License Number State | KS
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