Healthcare Provider Details

I. General information

NPI: 1609780444
Provider Name (Legal Business Name): JESSICA NICOLE BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23511 56TH AVE W STE 105
MOUNTLAKE TERRACE WA
98043-5285
US

IV. Provider business mailing address

2117 N 90TH ST
SEATTLE WA
98103-4123
US

V. Phone/Fax

Practice location:
  • Phone: 206-546-2421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: