Provider Demographics
NPI:1083882112
Name:FERGODA, JAYME DEE (PHD, LICSW)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:DEE
Last Name:FERGODA
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 E. MAPLE STREET
Mailing Address - Street 2:STE. 224
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-685-4224
Mailing Address - Fax:360-685-4222
Practice Address - Street 1:1313 E. MAPLE STREET
Practice Address - Street 2:STE. 224
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-685-4224
Practice Address - Fax:360-685-4222
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000056511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical