Provider Demographics
NPI:1003962812
Name:CHEN, JEANETTE J (PHD)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:J
Last Name:CHEN
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 1:14535 BEL RED RD STE B-200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3907
Mailing Address - Country:US
Mailing Address - Phone:425-635-0176
Mailing Address - Fax:425-745-1746
Practice Address - Street 1:14535 BEL RED RD STE B-200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3907
Practice Address - Country:US
Practice Address - Phone:425-635-0176
Practice Address - Fax:425-745-1746
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000850103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral