Provider Demographics
NPI:1609581040
Name:PEARCE, JESSA KARENE (SUDPT)
Entity type:Individual
Prefix:
First Name:JESSA
Middle Name:KARENE
Last Name:PEARCE
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 W MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2031
Mailing Address - Country:US
Mailing Address - Phone:360-453-7715
Mailing Address - Fax:949-955-5758
Practice Address - Street 1:749 SE PIONEER WAY STE 202
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5792
Practice Address - Country:US
Practice Address - Phone:360-524-3249
Practice Address - Fax:844-440-2147
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61413537175T00000X
WACO61490576101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist