Healthcare Provider Details

I. General information

NPI: 1477137958
Provider Name (Legal Business Name): JESSICA ANNE LIZOTTE RN.61070717
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 THOMPSON DR
SEDRO WOOLLEY WA
98284-5007
US

IV. Provider business mailing address

7440 W MARGINAL WAY S
SEATTLE WA
98108-4141
US

V. Phone/Fax

Practice location:
  • Phone: 360-856-3186
  • Fax:
Mailing address:
  • Phone: 360-856-3186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRN.61070717
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN.61070717
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: