Basic Information
| Provider Information | |||||||||
| NPI: | 1114244589 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASHINGTON | ||||||||
| FirstName: | JESSYCA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | BHRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4801 N CLASSEN BLVD | ||||||||
| Address2: | STE 159 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731184627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056076670 | ||||||||
| FaxNumber: | 4056076671 | ||||||||
| Practice Location | |||||||||
| Address1: | 4801 N CLASSEN BLVD | ||||||||
| Address2: | STE 159 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731184627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056076670 | ||||||||
| FaxNumber: | 4056076671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2010 | ||||||||
| LastUpdateDate: | 04/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | J081959238 | OK | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.