Provider Demographics
NPI:1255614012
Name:WEBER, JONATHAN (PSYD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:WEBER
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 1:4039 E LAKE SAMMAMISH SHORE LN SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-7479
Mailing Address - Country:US
Mailing Address - Phone:425-269-2955
Mailing Address - Fax:
Practice Address - Street 1:1400 NE CAMPUS PKWY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6622
Practice Address - Country:US
Practice Address - Phone:425-269-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WAPY60809963103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAICAN912OtherLA COUNTY DMH