Provider Demographics
NPI:1447676655
Name:BEEBE, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BEEBE
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 1:40600 NE 241ST AVE
Mailing Address - Street 2:
Mailing Address - City:AMBOY
Mailing Address - State:WA
Mailing Address - Zip Code:98601
Mailing Address - Country:US
Mailing Address - Phone:360-247-6004
Mailing Address - Fax:
Practice Address - Street 1:40600 NE 221ST AVE
Practice Address - Street 2:
Practice Address - City:AMBOY
Practice Address - State:WA
Practice Address - Zip Code:98601-3850
Practice Address - Country:US
Practice Address - Phone:360-247-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60257363225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist