Provider Demographics
NPI:1417596420
Name:SAMS, JESSICA (MSW, LICSW-A)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SAMS
Suffix:
Gender:F
Credentials:MSW, LICSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 W BOONE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-5029
Mailing Address - Country:US
Mailing Address - Phone:509-325-7232
Mailing Address - Fax:
Practice Address - Street 1:910 W BOONE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-5029
Practice Address - Country:US
Practice Address - Phone:509-325-7232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC609109571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical