Provider Demographics
NPI:1225537798
Name:WELLNESS AND REHABILITATION PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:WELLNESS AND REHABILITATION PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:STEVENSON
Authorized Official - Last Name:JUTTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-445-2664
Mailing Address - Street 1:10016 EDMONDS WAY STE C121
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-5107
Mailing Address - Country:US
Mailing Address - Phone:206-445-2664
Mailing Address - Fax:
Practice Address - Street 1:10016 EDMONDS WAY STE C121
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5107
Practice Address - Country:US
Practice Address - Phone:206-445-2664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60137402103TC0700X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1689980302Medicaid