Provider Demographics
NPI:1467436824
Name:SMITH, JESSICA LEIGH (MA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:TEMPLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:820 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2028
Mailing Address - Country:US
Mailing Address - Phone:509-663-8711
Mailing Address - Fax:
Practice Address - Street 1:820 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2028
Practice Address - Country:US
Practice Address - Phone:509-663-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001636231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0167983OtherL&I
WA1467436824Medicaid
WAP01290256OtherRR MEDICARE
WAA79319Medicare UPIN
WA1467436824Medicaid