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General NPI Number Information
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NPI Number | 1497235600
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Entity Type | Individual
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Provider Name | JESSICA L WASHINGTON
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Gender | Female
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 912 NE KELLY AVE
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City | GRESHAM
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State | OR
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Zip | 97030-5629
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Country | US
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Telephone | 503-912-5502
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Fax |
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Provider Business Mailing Address
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Address Line | 1950 SW 20TH CT
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City | GRESHAM
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State | OR
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Zip | 97080-5791
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Country | US
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Telephone | 971-200-9910
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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