Provider Demographics
NPI:1265908529
Name:HYDE, JONNIE SUE (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:JONNIE
Middle Name:SUE
Last Name:HYDE
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14176 NE 244TH ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604
Mailing Address - Country:US
Mailing Address - Phone:360-687-6895
Mailing Address - Fax:
Practice Address - Street 1:6926 NE FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7254
Practice Address - Country:US
Practice Address - Phone:360-993-3186
Practice Address - Fax:360-993-3047
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001956103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist