Provider Demographics
NPI:1073556742
Name:FREW, JON (PHD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:FREW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 SE CUTTER LN
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-8085
Mailing Address - Country:US
Mailing Address - Phone:360-693-1480
Mailing Address - Fax:
Practice Address - Street 1:1731 SE CUTTER LN
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-8085
Practice Address - Country:US
Practice Address - Phone:360-693-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1369103TB0200X
OR576103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral