Provider Demographics
NPI:1073870762
Name:TALEVICH, JESSICA SUZ-ANNE (MA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SUZ-ANNE
Last Name:TALEVICH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:SUZ-ANNE
Other - Last Name:SCHREIBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:21005 83RD AVE W
Mailing Address - Street 2:#15
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7051
Mailing Address - Country:US
Mailing Address - Phone:425-361-7778
Mailing Address - Fax:
Practice Address - Street 1:3101 OAKES AVE FL 2
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:360-296-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60855861101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health