Provider Demographics
NPI:1144642646
Name:MAZARIEGOS, JESSICA (MA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MAZARIEGOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 OCHOCO LN
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5198
Mailing Address - Country:US
Mailing Address - Phone:509-205-2688
Mailing Address - Fax:
Practice Address - Street 1:6002 OCHOCO LN
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5198
Practice Address - Country:US
Practice Address - Phone:509-205-2688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60426140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health