Provider Demographics
NPI:1578886644
Name:BESTWICK, JAN M (PHD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:M
Last Name:BESTWICK
Suffix:
Gender:F
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:PO BOX 5402
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85376-5402
Mailing Address - Country:US
Mailing Address - Phone:714-290-4015
Mailing Address - Fax:
Practice Address - Street 1:3322 164TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-3238
Practice Address - Country:US
Practice Address - Phone:714-290-4015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60031165103TF0200X
GAPSY 003290103TC0700X
WAPY60031165103TC0700X
GAPSY003290103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical