Provider Demographics
NPI:1336528306
Name:ST. CLAIR, JESSICA L (MA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:ST. CLAIR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:HAFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2510 MEADOW AVE N
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-2527
Mailing Address - Country:US
Mailing Address - Phone:206-850-1987
Mailing Address - Fax:
Practice Address - Street 1:5100 S. DAWSON ST.
Practice Address - Street 2:#104
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2100
Practice Address - Country:US
Practice Address - Phone:206-475-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-23
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60582835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health