Provider Demographics
NPI:1699982066
Name:LEITH, JESSICA MICHELLE (MS INTERN)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:MICHELLE
Last Name:LEITH
Suffix:
Gender:F
Credentials:MS INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W ROY ST
Mailing Address - Street 2:APT 110
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4484
Mailing Address - Country:US
Mailing Address - Phone:517-402-3014
Mailing Address - Fax:
Practice Address - Street 1:1025 S 3RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-2765
Practice Address - Country:US
Practice Address - Phone:425-271-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist