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General NPI Number Information
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NPI Number | 1912796442
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Entity Type | Individual
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Provider Name | JESSICA MACIAS
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Gender | Female
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 5301 TIETON DR
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City | YAKIMA
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State | WA
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Zip | 98908-3479
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Country | US
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Telephone | 509-965-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 912 BING ST
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City | GRANDVIEW
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State | WA
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Zip | 98930-3004
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 70049384
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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