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General NPI Number Information
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NPI Number | 1932602232
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Entity Type | Individual
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Provider Name | JESSICA RODRIGUEZ LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 4526 FEDERAL AVE
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City | EVERETT
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State | WA
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Zip | 98203-2132
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Country | US
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Telephone | 425-349-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 453 S ASH AVE
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City | KUNA
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State | ID
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Zip | 83634-2241
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LMSW37181
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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