Provider Demographics
NPI:1851143549
Name:PUCCIO, JAMEE DIANE (MASTERS STUDENT INTE)
Entity Type:Individual
Prefix:
First Name:JAMEE
Middle Name:DIANE
Last Name:PUCCIO
Suffix:
Gender:F
Credentials:MASTERS STUDENT INTE
Other - Prefix:
Other - First Name:JAMEE
Other - Middle Name:DIANE
Other - Last Name:ESLICKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:615 N MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-3148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:704 W HOOD AVE STE D2
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-1529
Practice Address - Country:US
Practice Address - Phone:541-640-9310
Practice Address - Fax:360-326-1978
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health