Provider Demographics
NPI:1235736117
Name:LE, JESSIE THANH
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:THANH
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7665 CLOVER BLOSSOM LN NE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3907
Mailing Address - Country:US
Mailing Address - Phone:503-602-6898
Mailing Address - Fax:
Practice Address - Street 1:20455 1ST AVE NE APT J302
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9386
Practice Address - Country:US
Practice Address - Phone:503-602-6898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61102442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist