Healthcare Provider Details

I. General information

NPI: 1194651604
Provider Name (Legal Business Name): JESSICA LIEBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W RIVERSIDE AVE STE N
SPOKANE WA
99201-0581
US

IV. Provider business mailing address

PO BOX 9031
YAKIMA WA
98909-0031
US

V. Phone/Fax

Practice location:
  • Phone: 509-731-3473
  • Fax:
Mailing address:
  • Phone: 509-731-3473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWIA.SC.61587589
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: