Provider Demographics
NPI:1689357493
Name:JESPERSEN, DAVID WALTER (MS, LMHC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WALTER
Last Name:JESPERSEN
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 139TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-4763
Mailing Address - Country:US
Mailing Address - Phone:425-879-9683
Mailing Address - Fax:
Practice Address - Street 1:2905 139TH AVE SE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-4763
Practice Address - Country:US
Practice Address - Phone:425-879-9683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004334101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health