Provider Demographics
NPI:1972804441
Name:PAQUE, JESSIE JADE
Entity type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:JADE
Last Name:PAQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:JADE
Other - Last Name:JIMMICUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1026 EAST FIRST STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362
Mailing Address - Country:US
Mailing Address - Phone:360-452-4432
Mailing Address - Fax:
Practice Address - Street 1:24373 HIGHWAY 112 STE 2
Practice Address - Street 2:
Practice Address - City:CLALLAM BAY
Practice Address - State:WA
Practice Address - Zip Code:98326-9606
Practice Address - Country:US
Practice Address - Phone:360-640-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)