Healthcare Provider Details

I. General information

NPI: 1316497183
Provider Name (Legal Business Name): JESSICA NORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 S CEDAR ST SUITE A
TACOMA WA
98409-5728
US

IV. Provider business mailing address

3680 S CEDAR ST SUITE A
TACOMA WA
98409-5728
US

V. Phone/Fax

Practice location:
  • Phone: 253-358-0888
  • Fax: 253-474-3267
Mailing address:
  • Phone: 253-358-0888
  • Fax: 253-474-3267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-23035
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: