Provider Demographics
NPI:1154585503
Name:WEBB, JESSICA M S (LMP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M S
Last Name:WEBB
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JEZY
Other - Middle Name:
Other - Last Name:LMP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:5631 TACOMA MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6901
Mailing Address - Country:US
Mailing Address - Phone:253-682-0220
Mailing Address - Fax:
Practice Address - Street 1:5631 TACOMA MALL BLVD
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6901
Practice Address - Country:US
Practice Address - Phone:253-682-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008631172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker