Provider Demographics
NPI:1780053454
Name:MASON, JESSICA RENEE (PHD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:MASON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11805 N ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1956
Mailing Address - Country:US
Mailing Address - Phone:928-710-4288
Mailing Address - Fax:509-358-7983
Practice Address - Street 1:412 E SPOKANE FALLS BLVD # 145D
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2131
Practice Address - Country:US
Practice Address - Phone:509-358-7533
Practice Address - Fax:509-358-7983
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60618318103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling