Provider Demographics
NPI:1417610130
Name:FELDMAN, JESSICA (MS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FELDMAN
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 1:1400 LAKE WASHINGTON BLVD N APT C312
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-6408
Mailing Address - Country:US
Mailing Address - Phone:610-406-7179
Mailing Address - Fax:
Practice Address - Street 1:1400 LAKE WASHINGTON BLVD N APT C312
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-6408
Practice Address - Country:US
Practice Address - Phone:610-406-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAGT61214734170300000X
MAGC625170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS