# BONNEY LAKE PSYCHIATRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467313858
- **Authorized official:** JESSICA NORMAN PMHNP (PSYCHIATRIC NURSE PRACTITIONER)
- **Authorized official phone:** (808) 209-1455

## Contact information

- **Practice address:** 10634 E RIVERSIDE DR STE 130, BOTHELL, WA 98011-3758
- **Practice address phone:** (503) 512-0840
- **Mailing address:** 100 N HOWARD ST STE R, SPOKANE, WA 99201-0508

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/24/2025
- **Last updated:** 11/24/2025