Provider Demographics
NPI:1972069029
Name:BAYER, JENNIFER L (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BAYER
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 1:1140 10TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7053
Mailing Address - Country:US
Mailing Address - Phone:360-319-9930
Mailing Address - Fax:
Practice Address - Street 1:1140 10TH ST STE 203
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7053
Practice Address - Country:US
Practice Address - Phone:360-319-9930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60176199133N00000X
WAPY60902082103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No133N00000XDietary & Nutritional Service ProvidersNutritionist