Provider Demographics
NPI:1568939825
Name:FURNISH-CODA, JESSICA LYN (SUDPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYN
Last Name:FURNISH-CODA
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 S 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3626
Mailing Address - Country:US
Mailing Address - Phone:360-681-7755
Mailing Address - Fax:360-681-5999
Practice Address - Street 1:526 S 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3626
Practice Address - Country:US
Practice Address - Phone:360-681-5983
Practice Address - Fax:360-681-5999
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
WACO61263005101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist