Provider Demographics
NPI:1568926160
Name:ROSENBERGER, JESSSICA (175T00000X)
Entity type:Individual
Prefix:
First Name:JESSSICA
Middle Name:
Last Name:ROSENBERGER
Suffix:
Gender:F
Credentials:175T00000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 14TH AVE S APT A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-4804
Mailing Address - Country:US
Mailing Address - Phone:206-708-0990
Mailing Address - Fax:
Practice Address - Street 1:1600 S LANE ST, SEATTLE, WA 98144
Practice Address - Street 2:APT A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144
Practice Address - Country:US
Practice Address - Phone:206-682-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
WACG60867049175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist