Provider Demographics
NPI:1447412721
Name:MASON, JESSICA MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MICHELLE
Last Name:MASON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ADMIRAL WAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-7230
Mailing Address - Country:US
Mailing Address - Phone:425-998-8632
Mailing Address - Fax:
Practice Address - Street 1:300 ADMIRAL WAY
Practice Address - Street 2:SUITE 209
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-7230
Practice Address - Country:US
Practice Address - Phone:425-998-8632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60106834103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical