Active NPI
Jessica Lynn Peterson, PHD
- Clinical Psychologist
- Seattle, WA
National Provider Identifier
1801399431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 60801334
- Practice address
- 6901 Sand Point Way NE
Seattle, WA 98115-7869 - Phone
- (206) 987-2000
- NPI assigned
- Mar 9, 2018
- Last updated
- Jan 28, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 60801334 | WA | Primary |
Addresses
Primary practice location
6901 Sand Point Way NE
Seattle, WA 98115-7869
Mailing address
1525 NW 57TH St Unit 516
Seattle, WA 98107-5632
Phone (425) 417-7292
Other names 1
- Dr. Jessica Lynn Berg
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60801334 | WA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Seattle Children's Hospital | Current | Accepting new patients | |
| Seattle Children's Hospital | Current | Accepting new patients |
Locations
4800 Sand Point Way NE
Seattle, WA 98105
Phone (206) 526-2000
Interoperability endpoints
- jpeterson3722@direct.seattlechildrens.org
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Specialist
- Seattle, WA
- NPI 1003319500
-
- Psychiatric Hospital Unit
- Seattle, WA
- NPI 1477622595
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706400000000",
"number": "1801399431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1525 NW 57TH ST UNIT 516",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981075632",
"telephone_number": "425-417-7292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6901 SAND POINT WAY NE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981157869",
"telephone_number": "206-987-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JESSICA",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-09",
"last_updated": "2024-01-28",
"certification_date": "2024-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "60801334",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "BERG",
"middle_name": "LYNN",
"prefix": "DR.",
"credential": "PHD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.