Provider Demographics
NPI:1215539622
Name:COFLER-SUAREZ, JESSICA ROXANA (MC, SC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROXANA
Last Name:COFLER-SUAREZ
Suffix:
Gender:F
Credentials:MC, SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4732 S KEYES CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-8276
Mailing Address - Country:US
Mailing Address - Phone:509-336-2756
Mailing Address - Fax:
Practice Address - Street 1:4732 S KEYES CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-8276
Practice Address - Country:US
Practice Address - Phone:509-336-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC56118171R00000X
171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter