Provider Demographics
NPI:1891576815
Name:HUGHES, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9601 339TH ST S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580-9480
Mailing Address - Country:US
Mailing Address - Phone:360-628-0993
Mailing Address - Fax:
Practice Address - Street 1:9601 339TH ST S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:WA
Practice Address - Zip Code:98580-9480
Practice Address - Country:US
Practice Address - Phone:360-628-0993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61483040106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty