Provider Demographics
NPI:1639882731
Name:CHAMPION, JESSICA JUSTICE (CPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JUSTICE
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4811
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98063-4811
Mailing Address - Country:US
Mailing Address - Phone:206-251-7953
Mailing Address - Fax:
Practice Address - Street 1:28826 28TH PL S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7901
Practice Address - Country:US
Practice Address - Phone:206-251-7953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist