Healthcare Provider Details

I. General information

NPI: 1912796442
Provider Name (Legal Business Name): JESSICA MACIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 TIETON DR
YAKIMA WA
98908-3479
US

IV. Provider business mailing address

912 BING ST
GRANDVIEW WA
98930-3004
US

V. Phone/Fax

Practice location:
  • Phone: 509-965-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number70049384
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: