Provider Demographics
NPI:1013781962
Name:SMITH, JESIKA (MS)
Entity Type:Individual
Prefix:
First Name:JESIKA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4033 TALBOT RD S STE 450
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5767
Mailing Address - Country:US
Mailing Address - Phone:425-690-3477
Mailing Address - Fax:425-690-9477
Practice Address - Street 1:4033 TALBOT RD S STE 450
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5767
Practice Address - Country:US
Practice Address - Phone:425-690-3477
Practice Address - Fax:425-690-9477
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAGT61495239170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS