Provider Demographics
NPI:1356785786
Name:RHODES, JESSICA CAROL (CDP)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:CAROL
Last Name:RHODES
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10564 5TH AVE NE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7200
Mailing Address - Country:US
Mailing Address - Phone:206-957-0721
Mailing Address - Fax:206-957-0723
Practice Address - Street 1:10564 5TH AVE NE
Practice Address - Street 2:SUITE 406
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7200
Practice Address - Country:US
Practice Address - Phone:206-957-0721
Practice Address - Fax:206-957-0723
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17113800101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
457614007OtherEIN