Provider Demographics
NPI:1801364237
Name:LIVOLSI, JESSICA KATHERINE (SWEDISH CERTIFICATE)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATHERINE
Last Name:LIVOLSI
Suffix:
Gender:F
Credentials:SWEDISH CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24304 78TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-9388
Mailing Address - Country:US
Mailing Address - Phone:253-495-5530
Mailing Address - Fax:
Practice Address - Street 1:5213 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7695
Practice Address - Country:US
Practice Address - Phone:253-474-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-03
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60894810225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist