Healthcare Provider Details

I. General information

NPI: 1649051277
Provider Name (Legal Business Name): JESSICA EGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA EGAN

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 NE 109TH AVENUE
VANCOUVER WA
98682
US

IV. Provider business mailing address

3200 NE 109TH AVENUE
VANCOUVER WA
98682
US

V. Phone/Fax

Practice location:
  • Phone: 360-695-1014
  • Fax:
Mailing address:
  • Phone: 360-695-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG61613884
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC70028483
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: