Provider Demographics
NPI:1730271313
Name:DAFFON, JENNIFER KLOCKER (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KLOCKER
Last Name:DAFFON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19730 64TH AVE W STE 301
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5957
Mailing Address - Country:US
Mailing Address - Phone:425-686-9627
Mailing Address - Fax:206-489-3100
Practice Address - Street 1:19730 64TH AVE W STE 301
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5957
Practice Address - Country:US
Practice Address - Phone:425-686-9627
Practice Address - Fax:206-489-3100
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WAPY60815519103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health