Healthcare Provider Details

I. General information

NPI: 1912814385
Provider Name (Legal Business Name): JESSICA THI HAYNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 BROADWAY STE 301
TACOMA WA
98402-4454
US

IV. Provider business mailing address

2110 SW 337TH PL APT 205
FEDERAL WAY WA
98023-7782
US

V. Phone/Fax

Practice location:
  • Phone: 253-292-4354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number70169771
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: