Provider Demographics
NPI:1710313598
Name:MERCER, JESSICA ERIN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ERIN
Last Name:MERCER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ERIN
Other - Last Name:GOESMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:81 HAVEN RD APT B
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-5747
Mailing Address - Country:US
Mailing Address - Phone:573-586-7134
Mailing Address - Fax:
Practice Address - Street 1:9621 MICKELBERRY RD NW STE 108
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8301
Practice Address - Country:US
Practice Address - Phone:360-692-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60400870225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist