Provider Demographics
NPI:1689980302
Name:JUTTE, JENNIFER STEVENSON (MPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:STEVENSON
Last Name:JUTTE
Suffix:
Gender:F
Credentials:MPH, PHD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ERIN
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, PHD
Mailing Address - Street 1:10016 EDMONDS WAY STE C121
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-5107
Mailing Address - Country:US
Mailing Address - Phone:206-445-2664
Mailing Address - Fax:
Practice Address - Street 1:10016 EDMONDS WAY STE C121
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5107
Practice Address - Country:US
Practice Address - Phone:206-445-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60137402103TC0700X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA317623OtherL&I PIN
WA1689980302Medicaid
WA1689980302Medicaid