Provider Demographics
NPI:1134279516
Name:DESHAYES, JESSICA JO (LMP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JO
Last Name:DESHAYES
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 1:5963 SW CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3528
Mailing Address - Country:US
Mailing Address - Phone:206-387-3944
Mailing Address - Fax:
Practice Address - Street 1:5963 SW CARROLL ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3528
Practice Address - Country:US
Practice Address - Phone:206-387-3944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist