Provider Demographics
NPI:1306934773
Name:BROWN, JESSICA LYNNE (PT)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LYNNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LYNNE
Other - Last Name:DIGIACOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4245 ROOSEVELT WAY N.E. W220
Mailing Address - Street 2:UW MEDICAL CENTER
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-598-2888
Mailing Address - Fax:
Practice Address - Street 1:4245 ROOSEVELT WAY N.E. W220
Practice Address - Street 2:UW MEDICAL CENTER
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-598-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNCP9297225100000X, 225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211634Medicaid
NC7211634Medicaid