Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 1369 | WA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 576 | OR |
NPI | 1073556742 |
---|---|
Provider Name | Dr. Jon Frew |
First Address | Vancouver, WA 98661-8085 |
Second Address | Vancouver, WA 98661-8085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 08/07/2007 |