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1801399431 NPI number — JESSICA LYNN PETERSON PHD

NPI Number: 1801399431
Health Care Provider/Practitioner: JESSICA LYNN PETERSON PHD

Information about “1801399431” NPI (JESSICA LYNN PETERSON PHD) exists in 1801399431 in HTML format HTML  |  1801399431 in plain Text format TXT  |  1801399431 in PDF (Portable Document Format) PDF  |  1801399431 in an XML format XML  formats.

NPI Number : 1801399431 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1801399431",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PETERSON",
    "FirstName": "JESSICA",
    "MiddleName": "LYNN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BERG",
    "OtherFirstName": "JESSICA",
    "OtherMiddleName": "LYNN",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PHD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1525 NW 57TH ST UNIT 516",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SEATTLE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98107-5632",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "425-417-7292",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6901 SAND POINT WAY NE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SEATTLE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98115-7869",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "206-987-2000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/09/2018",
    "LastUpdateDate": "01/28/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103TC0700X",
        "TaxonomyName": "Clinical Psychologist",
        "LicenseNumber": "60801334",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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