Provider Demographics
NPI:1144915349
Name:WADDING, JESSICA ANN (SUDP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:WADDING
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-4614
Mailing Address - Country:US
Mailing Address - Phone:360-337-5735
Mailing Address - Fax:
Practice Address - Street 1:1026 SIDNEY AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4214
Practice Address - Country:US
Practice Address - Phone:360-337-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61363650101YA0400X
WACO61536449101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)