Provider Demographics
NPI:1679646004
Name:MATTSON, JENNIFER MARGARET (MS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARGARET
Last Name:MATTSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W SPRUCE ST STE 32
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3222
Mailing Address - Country:US
Mailing Address - Phone:509-966-2632
Mailing Address - Fax:
Practice Address - Street 1:1111 W SPRUCE ST STE 32
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3222
Practice Address - Country:US
Practice Address - Phone:509-966-2632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004275101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health