Healthcare Provider Details

I. General information

NPI: 1073338851
Provider Name (Legal Business Name): JESSICA MATHER GC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 CATON WAY SW STE A2
OLYMPIA WA
98502-2100
US

IV. Provider business mailing address

2008 CATON WAY SW STE A2
OLYMPIA WA
98502-2100
US

V. Phone/Fax

Practice location:
  • Phone: 360-485-0115
  • Fax: 844-813-3892
Mailing address:
  • Phone: 360-485-0115
  • Fax: 844-813-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGCP-P-10247795
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGT61604470
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: