Provider Demographics
NPI:1134845787
Name:STILES, JESSICA RENE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENE
Last Name:STILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 S 18TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4265
Mailing Address - Country:US
Mailing Address - Phone:509-834-0632
Mailing Address - Fax:
Practice Address - Street 1:107 S 7TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3385
Practice Address - Country:US
Practice Address - Phone:509-453-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61355726225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist