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NPI Code Detail

MEDICARE: JESSICA SARAHMARIE FITZGERALD BS, R-AAC, SUDP

MEDICARE: JESSICA SARAHMARIE FITZGERALD BS, R-AAC, SUDP
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCP60636603WA

General Provider Information

NPI Number : 1447619234
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA SARAHMARIE FITZGERALD BS, R-AAC, SUDP
Provider Business Mailing Address
First Line : PO BOX 2394
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-8455
Country : US
Telephone Number : 360-998-2047
Fax Number : 360-200-6736
Provider Business Practice Location Address
First Line : 1400 COMMERCE AVE
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-3756
Country : US
Telephone Number : 360-998-2047
Fax Number : 360-200-6736
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2016
Last Update Date : 09/11/2025

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