Individual
MRS. JESICA C PRUITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
9818 NE 200TH ST, BOTHELL, WA 98011-2300
(425) 941-3768
Mailing address
9818 NE 200TH ST, BOTHELL, WA 98011-2300
(425) 941-3768
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL00004202
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12090673
ASHA NUMBER
WA
05
—
7028319
—
WA
01
—
7411852
AETNA PROVIDER NUMBER
WA
05
—
8461469
—
WA
Enumeration date
11/29/2006
Last updated
09/12/2008
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