Provider Demographics
NPI:1093982373
Name:WEISS, JESSICA ANN (LMP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANN
Last Name:WEISS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-0154
Mailing Address - Country:US
Mailing Address - Phone:206-227-0573
Mailing Address - Fax:
Practice Address - Street 1:14524 MAIN ST NE
Practice Address - Street 2:#115
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8467
Practice Address - Country:US
Practice Address - Phone:206-227-0573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024069225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist