Provider Demographics
NPI:1205147410
Name:SIMPSON, JOLENE (PHD)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:SIMPSON
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 1:17650 134TH AVE SE
Mailing Address - Street 2:L304
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-6889
Mailing Address - Country:US
Mailing Address - Phone:206-518-8019
Mailing Address - Fax:
Practice Address - Street 1:17650 134TH AVE SE
Practice Address - Street 2:L304
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-6889
Practice Address - Country:US
Practice Address - Phone:206-518-8019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist