Provider Demographics
NPI:1265665632
Name:JEMEYSON, DEBBY JO (CPD, BSW)
Entity Type:Individual
Prefix:MS
First Name:DEBBY
Middle Name:JO
Last Name:JEMEYSON
Suffix:
Gender:F
Credentials:CPD, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E COLLEGE WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5862
Mailing Address - Country:US
Mailing Address - Phone:360-399-1311
Mailing Address - Fax:360-336-3815
Practice Address - Street 1:2500 E COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5862
Practice Address - Country:US
Practice Address - Phone:360-399-1311
Practice Address - Fax:360-336-3815
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005481101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1994565Medicaid