Provider Demographics
NPI:1770031965
Name:TODD, JESSICA (MA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:PERSING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2604 EVERGREEN PARK RD
Mailing Address - Street 2:
Mailing Address - City:GRAYLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98547-9745
Mailing Address - Country:US
Mailing Address - Phone:303-990-3467
Mailing Address - Fax:
Practice Address - Street 1:2604 EVERGREEN PARK RD
Practice Address - Street 2:
Practice Address - City:GRAYLAND
Practice Address - State:WA
Practice Address - Zip Code:98547-9745
Practice Address - Country:US
Practice Address - Phone:303-990-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61072722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health