Basic Information
| Provider Information | |||||||||
| NPI: | 1649882440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENWOOD | ||||||||
| FirstName: | JESS | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | GREENWOOD | ||||||||
| OtherFirstName: | JESSICA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 610 CRUSHER CANYON RD | ||||||||
| Address2: | |||||||||
| City: | SELAH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989421807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092282399 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3801 KERN WAY | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989026340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095743200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2020 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | Y | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
No ID Information.