Individual
JESSICA ANN SUMMERVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1498 SE TECH CENTER PL STE 300, VANCOUVER, WA 98683-5509
(360) 200-8756
Mailing address
1498 SE TECH CENTER PL STE 300, VANCOUVER, WA 98683-5509
(360) 560-8846
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LH61164216
WA
1041C0700X
Clinical Social Worker
Primary
LW61396047
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
911585652
—
WA
Enumeration date
08/20/2018
Last updated
01/23/2025
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