Provider Demographics
NPI:1184762155
Name:STEVENS, JONATHAN D (PSYD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:STEVENS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 E LAURIDSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7978
Mailing Address - Country:US
Mailing Address - Phone:360-457-1610
Mailing Address - Fax:253-477-2287
Practice Address - Street 1:430 E LAURIDSEN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7978
Practice Address - Country:US
Practice Address - Phone:360-457-1610
Practice Address - Fax:253-477-2287
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04219103TC0700X
WAPY60914599103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical