Provider Demographics
NPI:1003179565
Name:CABASAG, JESSIE AMAN
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:AMAN
Last Name:CABASAG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2831
Mailing Address - Country:US
Mailing Address - Phone:206-323-0930
Mailing Address - Fax:206-328-3757
Practice Address - Street 1:1116 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2831
Practice Address - Country:US
Practice Address - Phone:206-323-0930
Practice Address - Fax:206-328-3757
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor