Provider Demographics
NPI:1962810556
Name:LINGO, JESICA
Entity type:Individual
Prefix:
First Name:JESICA
Middle Name:
Last Name:LINGO
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 1:637 YAKIMA ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2816
Mailing Address - Country:US
Mailing Address - Phone:509-667-0679
Mailing Address - Fax:509-663-0441
Practice Address - Street 1:637 YAKIMA ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2816
Practice Address - Country:US
Practice Address - Phone:509-667-0679
Practice Address - Fax:509-663-0441
Is Sole Proprietor?:No
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60426128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1126911Medicaid