Provider Demographics
NPI:1396183406
Name:GROUT, JESSICA DAWN SVEDBERG (LMFTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN SVEDBERG
Last Name:GROUT
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 VALLEY AVE NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-2530
Mailing Address - Country:US
Mailing Address - Phone:253-343-2360
Mailing Address - Fax:
Practice Address - Street 1:601 VALLEY AVE NE
Practice Address - Street 2:SUITE B
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-2530
Practice Address - Country:US
Practice Address - Phone:253-343-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60535996106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist