Provider Demographics
NPI:1700246246
Name:SALVESEN, JESAMIE FLYNN (MA)
Entity Type:Individual
Prefix:MS
First Name:JESAMIE
Middle Name:FLYNN
Last Name:SALVESEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4525 164TH ST SW APT H302
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-8626
Mailing Address - Country:US
Mailing Address - Phone:707-616-0885
Mailing Address - Fax:206-770-7214
Practice Address - Street 1:4525 164TH ST SW APT H302
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8626
Practice Address - Country:US
Practice Address - Phone:707-616-0885
Practice Address - Fax:206-770-7214
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60765085106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMG60765085OtherMARRIAGE AND FAMILY THERAPIST ASSOCIATE LICENSE