Provider Demographics
NPI:1619956844
Name:VIERGUTZ-CAVAGNETTO, JESSICA LEIGH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEIGH
Last Name:VIERGUTZ-CAVAGNETTO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:VIERGUTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:107 SOUTH GRAND AVENUE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163
Mailing Address - Country:US
Mailing Address - Phone:509-332-2600
Mailing Address - Fax:509-362-9892
Practice Address - Street 1:107 SOUTH GRAND AVENUE
Practice Address - Street 2:SUITE D
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163
Practice Address - Country:US
Practice Address - Phone:509-332-2600
Practice Address - Fax:509-362-9892
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00977103TC0700X
NY0168651103TC0700X
WAPY60317232103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical