Provider Demographics
NPI:1689830481
Name:JACKSON, JESSICA DOROTHY (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DOROTHY
Last Name:JACKSON
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 1:7605 SE 27TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2835
Mailing Address - Country:US
Mailing Address - Phone:206-275-4870
Mailing Address - Fax:
Practice Address - Street 1:7605 SE 27TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2835
Practice Address - Country:US
Practice Address - Phone:206-275-4870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60022019225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist