Provider Demographics
NPI:1023127289
Name:DYER, JEFFREY WILLIAM (CLINICIAN I)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:DYER
Suffix:
Gender:M
Credentials:CLINICIAN I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-8914
Mailing Address - Country:US
Mailing Address - Phone:360-419-3544
Mailing Address - Fax:360-419-3505
Practice Address - Street 1:1900 N 30TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-8914
Practice Address - Country:US
Practice Address - Phone:360-419-3544
Practice Address - Fax:360-419-3505
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00039751101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health