Provider Demographics
NPI:1851722433
Name:HELGESON, JADA (COTA/L)
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:
Last Name:HELGESON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14311 168TH ST E
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-9535
Mailing Address - Country:US
Mailing Address - Phone:360-893-2720
Mailing Address - Fax:
Practice Address - Street 1:805 OLD PIONEER WAY NW
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360-9466
Practice Address - Country:US
Practice Address - Phone:360-893-6500
Practice Address - Fax:360-893-4367
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00000135174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist