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NPI Code Detail

MEDICARE: DR. JEFF L VANNICE PHD

MEDICARE: DR. JEFF L VANNICE PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPY 60411752WA

General Provider Information

NPI Number : 1033125018
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFF L VANNICE PHD
Provider Business Mailing Address
First Line : 1415 6TH AVE N APT 402
Second Line :
City : SEATTLE
State : WA
Zip : 98109-3462
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13451 SE 36TH ST
Second Line :
City : BELLEVUE
State : WA
Zip : 98006-1475
Country : US
Telephone Number : 425-562-1337
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 05/06/2014

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