Provider Demographics
NPI:1609118363
Name:RAUGUST, JESSICA (LMP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RAUGUST
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 N PINES RD
Mailing Address - Street 2:STE 110
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6707
Mailing Address - Country:US
Mailing Address - Phone:509-869-3142
Mailing Address - Fax:509-315-8714
Practice Address - Street 1:1014 N PINES RD
Practice Address - Street 2:STE 110
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6707
Practice Address - Country:US
Practice Address - Phone:509-869-3142
Practice Address - Fax:509-315-8714
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60276304225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist