Provider Demographics
NPI:1275983447
Name:LUCAS, JESSIKA (MA60611103)
Entity Type:Individual
Prefix:
First Name:JESSIKA
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MA60611103
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 SAND POINT WAY NE UNIT A21
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6358
Mailing Address - Country:US
Mailing Address - Phone:425-686-0548
Mailing Address - Fax:
Practice Address - Street 1:8005 SAND POINT WAY NE UNIT A21
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6358
Practice Address - Country:US
Practice Address - Phone:425-686-0548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60611103225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist