Provider Demographics
NPI:1083442859
Name:CLAIRE, JENNIFER (PHD DD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:CLAIRE
Suffix:
Gender:F
Credentials:PHD DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1998 ADVANTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2009
Mailing Address - Country:US
Mailing Address - Phone:360-801-8067
Mailing Address - Fax:
Practice Address - Street 1:1998 ADVANTAGE AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2009
Practice Address - Country:US
Practice Address - Phone:360-801-8067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA23101280251K00000X
WA271996171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No251K00000XAgenciesPublic Health or Welfare