Individual
MRS. JESSICA WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
2745 38TH AVE, LONGVIEW, WA 98632-4721
(360) 575-7595
Mailing address
2715 LILAC ST, LONGVIEW, WA 98632-3526
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SI61472775
WA
Other
Enumeration date
09/05/2023
Last updated
09/05/2023
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