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19730 64th Ave W Ste 301 Lynnwood WA 98036-5957 | |
| (425) 686-9627 | |
| (206) 489-3100 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical Child & Adolescent |
| Location | 19730 64th Ave W Ste 301, Lynnwood, Washington |
| Authorized Official Name and Position | Jennifer Klocker Daffon (OWNER) |
| Authorized Official Contact | 4253442596 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
19730 64th Ave W Ste 301 Lynnwood WA 98036-5957 Ph: (425) 686-9627 | 19730 64th Ave W Ste 301 Lynnwood WA 98036-5957 Ph: (425) 686-9627 |
| NPI Number | 1629686654 |
|---|---|
| Provider Enumeration Date | 07/15/2020 |
| Last Update Date | 07/14/2023 |
| Certification Date | 07/14/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629686654 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 103TC2200X | Psychologist - Clinical Child & Adolescent | (* (Not Available)) | Primary |
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