Provider Demographics
NPI:1073797890
Name:KEAR, JERRY STEVEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:STEVEN
Last Name:KEAR
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 1:2820 NORTHUP WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1419
Mailing Address - Country:US
Mailing Address - Phone:206-218-3370
Mailing Address - Fax:425-889-0366
Practice Address - Street 1:2820 NORTHUP WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1419
Practice Address - Country:US
Practice Address - Phone:206-218-3370
Practice Address - Fax:425-889-0366
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002520103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB39225Medicare PIN