Provider Demographics
NPI:1104266501
Name:ARAMBUL, JESSIE L
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:L
Last Name:ARAMBUL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JESSIE
Other - Middle Name:L
Other - Last Name:STARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5807 W RUBY ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2771
Mailing Address - Country:US
Mailing Address - Phone:509-539-1447
Mailing Address - Fax:
Practice Address - Street 1:5807 W RUBY ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-2771
Practice Address - Country:US
Practice Address - Phone:509-539-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2023-10-03
Deactivation Date:2023-01-25
Deactivation Code:
Reactivation Date:2023-10-03
Provider Licenses
StateLicense IDTaxonomies
WALW60695496104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker