Provider Demographics
NPI:1447457007
Name:STOCCO, JESSI MICHELLE (LMP)
Entity type:Individual
Prefix:
First Name:JESSI
Middle Name:MICHELLE
Last Name:STOCCO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31600 126TH AVE SE
Mailing Address - Street 2:#76
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-0914
Mailing Address - Country:US
Mailing Address - Phone:206-948-8058
Mailing Address - Fax:
Practice Address - Street 1:13003 SE KENT KANGLEY RD
Practice Address - Street 2:STE 110
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7919
Practice Address - Country:US
Practice Address - Phone:253-638-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20-4685144OtherEIN