Provider Demographics
NPI:1487933040
Name:BEARSE, JENNIFER L (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:BEARSE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61809
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-1809
Mailing Address - Country:US
Mailing Address - Phone:360-603-9443
Mailing Address - Fax:
Practice Address - Street 1:800 OFFICERS ROW STE D
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3847
Practice Address - Country:US
Practice Address - Phone:360-603-9443
Practice Address - Fax:360-603-9442
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60463236103TP2701X, 103TC0700X
OR2527103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103T00000XBehavioral Health & Social Service ProvidersPsychologist