Individual
JESSE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
610 S YAKIMA AVE, TACOMA, WA 98405-4851
(253) 396-5823
Mailing address
605 10TH AVE, MILTON, WA 98354-8832
(206) 960-0696
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
WA
Other
Enumeration date
02/22/2022
Last updated
02/25/2022
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