Healthcare Provider Details

I. General information

NPI: 1447164637
Provider Name (Legal Business Name): JESSICA MOONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 NW 75TH ST
SEATTLE WA
98117-5318
US

IV. Provider business mailing address

9039 GREENWOOD AVE N APT 408
SEATTLE WA
98103-3980
US

V. Phone/Fax

Practice location:
  • Phone: 707-349-4425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number70098777
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: