MEDICARE: DR. JENNIFER KLOCKER DAFFON PSYD.

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
1	101YM0800X	Mental Health Counselor
2	103TC2200X	Clinical Child & Adolescent Psychologist	PY60815519	WA

General Provider Information

NPI Number	:	1730271313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER KLOCKER DAFFON PSYD.

Provider Business Mailing Address
First Line	:	19730 64TH AVE W STE 301
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-5957
Country	:	US
Telephone Number	:	425-686-9627
Fax Number	:	206-489-3100

Provider Business Practice Location Address
First Line	:	19730 64TH AVE W STE 301
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-5957
Country	:	US
Telephone Number	:	425-686-9627
Fax Number	:	206-489-3100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/14/2023

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