Individual
MS. JESSICA ELLEN MACKIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1959 NE PACIFIC ST, SEATTLE, WA 98195-0001
(206) 520-5000
Mailing address
1959 NE PACIFIC ST, SEATTLE, WA 98195-0001
(206) 520-5000
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
2020019040
MO
235Z00000X
Speech-Language Pathologist
Primary
LL61455027
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
460086824
—
MO
Enumeration date
08/02/2019
Last updated
08/15/2023
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