MEDICARE: DR. JESSICA LYNN PETERSON 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
1	103TC0700X	Clinical Psychologist	60801334	WA

General Provider Information

NPI Number	:	1801399431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA LYNN PETERSON PHD

Provider Business Mailing Address
First Line	:	1525 NW 57TH ST UNIT 516
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-5632
Country	:	US
Telephone Number	:	425-417-7292
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 SAND POINT WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-7869
Country	:	US
Telephone Number	:	206-987-2000
Fax Number	:

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

Provider Enumeration Date	:	03/09/2018
Last Update Date	:	01/28/2024

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