Provider Demographics
NPI:1982996062
Name:BLOOMGARDEN, JENNIFER L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:BLOOMGARDEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:B
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:19803 N CREEK PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-8214
Mailing Address - Country:US
Mailing Address - Phone:425-298-5151
Mailing Address - Fax:
Practice Address - Street 1:19803 N CREEK PKWY STE 205
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011
Practice Address - Country:US
Practice Address - Phone:425-298-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60709205103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical