Provider Demographics
NPI:1073338851
Name:MATHER, JESSICA (GC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MATHER
Suffix:
Gender:F
Credentials:GC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 CATON WAY SW STE A2
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-2100
Mailing Address - Country:US
Mailing Address - Phone:360-485-0115
Mailing Address - Fax:844-813-3892
Practice Address - Street 1:2008 CATON WAY SW STE A2
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-2100
Practice Address - Country:US
Practice Address - Phone:360-485-0115
Practice Address - Fax:844-813-3892
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORGCP-P-10247795170300000X
WAGT61604470170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS