Provider Demographics
NPI:1043826621
Name:SCALZO, JESSICA ERIN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:SCALZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 S JACKSON ST APT 242
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2182
Mailing Address - Country:US
Mailing Address - Phone:206-919-4041
Mailing Address - Fax:
Practice Address - Street 1:3250 AIRPORT WAY S STE 608
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-2172
Practice Address - Country:US
Practice Address - Phone:206-486-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program