Healthcare Provider Details

I. General information

NPI: 1780510917
Provider Name (Legal Business Name): JESSICA A JUDD RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10031 SE 258TH PL
KENT WA
98030-2887
US

IV. Provider business mailing address

4918 108TH ST SW APT 12
LAKEWOOD WA
98499-5619
US

V. Phone/Fax

Practice location:
  • Phone: 360-718-5311
  • Fax:
Mailing address:
  • Phone: 360-718-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: