Provider Demographics
NPI:1881929479
Name:DELAROSA, JESSICA ANN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:DELAROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 SUNSET WAY
Mailing Address - Street 2:
Mailing Address - City:COWICHE
Mailing Address - State:WA
Mailing Address - Zip Code:98923-9718
Mailing Address - Country:US
Mailing Address - Phone:509-969-3792
Mailing Address - Fax:509-783-6675
Practice Address - Street 1:3180 W CLEARWATER AVE
Practice Address - Street 2:STE. F.
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2767
Practice Address - Country:US
Practice Address - Phone:509-969-3792
Practice Address - Fax:509-783-6675
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60111627225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist