Provider Demographics
NPI:1326558784
Name:RYAN, JESSICA LEE (MS)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LEE
Last Name:RYAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 WESTERN AVE APT 605
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1082
Mailing Address - Country:US
Mailing Address - Phone:732-857-6593
Mailing Address - Fax:
Practice Address - Street 1:16401 SE 318TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-9285
Practice Address - Country:US
Practice Address - Phone:253-931-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist