Provider Demographics
NPI:1003244948
Name:KICHA, JESSICA (MA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:KICHA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 W. 2ND AVE., STE 100
Mailing Address - Street 2:NORTHWEST REGISTERED AGENT, LLC.
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-7684
Mailing Address - Country:US
Mailing Address - Phone:425-786-6192
Mailing Address - Fax:
Practice Address - Street 1:1400 112TH AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6901
Practice Address - Country:US
Practice Address - Phone:425-243-4722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60338137101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor