Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | MC60338137 | WA |
NPI | 1003244948 |
---|---|
Provider Name | Ms. Jessica Kicha |
First Address | Spokane, WA 99201-7684 |
Second Address | Bellevue, WA 98004-6901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2013 |
Last Update Date | 13/10/2015 |