Healthcare Provider Details

I. General information

NPI: 1780053454
Provider Name (Legal Business Name): JESSICA RENEE MASON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 11/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 E SPOKANE FALLS BLVD # 145D
SPOKANE WA
99202-2131
US

IV. Provider business mailing address

11805 N ATLANTIC ST
SPOKANE WA
99218-1956
US

V. Phone/Fax

Practice location:
  • Phone: 509-358-7533
  • Fax: 509-358-7983
Mailing address:
  • Phone: 928-710-4288
  • Fax: 509-358-7983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY60618318
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: