Provider Demographics
NPI:1235671918
Name:DANIELS, JESSICA ANN (MS, LMHC, SUDP, NCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MS, LMHC, SUDP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6855 W CLEARWATER AVE STE A101-293
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5011
Mailing Address - Country:US
Mailing Address - Phone:509-675-5349
Mailing Address - Fax:
Practice Address - Street 1:1710 W 8TH PL
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5232
Practice Address - Country:US
Practice Address - Phone:509-675-5349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60689400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1235671918Medicaid