Provider Demographics
NPI:1750784112
Name:GONZALES, JESSICA HELENA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HELENA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7345 164TH AVE NE # I1451301
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7846
Mailing Address - Country:US
Mailing Address - Phone:425-651-6890
Mailing Address - Fax:866-771-2215
Practice Address - Street 1:16771 NE 80TH ST STE 104
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3959
Practice Address - Country:US
Practice Address - Phone:425-651-6890
Practice Address - Fax:866-771-2215
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60505216363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health