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NPI Code Detail

MEDICARE: DR. BETHANY JILL GROSS PSY.D.

MEDICARE: DR. BETHANY JILL GROSS PSY.D.
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 PsychologistPY00002556WA

General Provider Information

NPI Number : 1851460281
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BETHANY JILL GROSS PSY.D.
Provider Business Mailing Address
First Line : 2200 24TH AVE E
Second Line :
City : SEATTLE
State : WA
Zip : 98112-3050
Country : US
Telephone Number : 206-778-2780
Fax Number :
Provider Business Practice Location Address
First Line : 2200 24TH AVE E
Second Line :
City : SEATTLE
State : WA
Zip : 98112-3050
Country : US
Telephone Number : 206-778-2780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 07/08/2007

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