Provider Demographics
NPI:1598819187
Name:WATSON, JENNIFER M (PHD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 EASTLAKE AVE E
Mailing Address - Street 2:SUITE 328
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3399
Mailing Address - Country:US
Mailing Address - Phone:206-331-2453
Mailing Address - Fax:206-905-5906
Practice Address - Street 1:2366 EASTLAKE AVE E
Practice Address - Street 2:SUITE 328
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3399
Practice Address - Country:US
Practice Address - Phone:206-331-2453
Practice Address - Fax:206-905-5906
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003646103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical