Individual
JACOB LEASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 NW 12TH AVE STE 107, BATTLE GROUND, WA 98604-9141
(360) 723-0528
Mailing address
21204 NW 31ST AVE, RIDGEFIELD, WA 98642-8523
(509) 342-9341
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/14/2024
Last updated
02/13/2026
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