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NPI Code Detail

MEDICARE: JESSICA ANN TUCKER

MEDICARE: JESSICA ANN TUCKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker63775CA

General Provider Information

NPI Number : 1205184280
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ANN TUCKER
Provider Business Mailing Address
First Line : 10215 LAKE CITY WAY NE STE H
Second Line :
City : SEATTLE
State : WA
Zip : 98125-7758
Country : US
Telephone Number : 206-417-9904
Fax Number :
Provider Business Practice Location Address
First Line : 10215 LAKE CITY WAY NE STE H
Second Line :
City : SEATTLE
State : WA
Zip : 98125-7758
Country : US
Telephone Number : 206-417-9904
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2012
Last Update Date : 07/21/2022

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Directions to “ JESSICA ANN TUCKER ” Practice Location

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