Provider Demographics
NPI:1962566786
Name:CLARKE, JENNIFER FINSTAD (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:FINSTAD
Last Name:CLARKE
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 1:406 S 1ST ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3897
Mailing Address - Country:US
Mailing Address - Phone:360-336-2593
Mailing Address - Fax:360-336-3270
Practice Address - Street 1:406 S 1ST ST STE 300
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3897
Practice Address - Country:US
Practice Address - Phone:360-336-2593
Practice Address - Fax:360-336-3270
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA306680001OtherGROUP HEALTH
WA06247OtherREGENCE
WAR12116Medicare UPIN
WA001100469Medicare ID - Type Unspecified
WA306680001OtherGROUP HEALTH