Provider Demographics
NPI:1659760965
Name:VERBRUGGE, JESSICA MARIE (RD, LMT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIE
Last Name:VERBRUGGE
Suffix:
Gender:F
Credentials:RD, LMT
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:WILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 1780
Mailing Address - Street 2:
Mailing Address - City:MAPLE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98266-1780
Mailing Address - Country:US
Mailing Address - Phone:360-739-7062
Mailing Address - Fax:
Practice Address - Street 1:7533 CANYON VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:WA
Practice Address - Zip Code:98244
Practice Address - Country:US
Practice Address - Phone:360-739-7062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60401354225700000X
WA86088742133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist