Provider Demographics
NPI:1487869483
Name:BERRYMAN, JESSICA SIDNEY (LMP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SIDNEY
Last Name:BERRYMAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3053 31ST AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-2724
Mailing Address - Country:US
Mailing Address - Phone:206-915-7870
Mailing Address - Fax:
Practice Address - Street 1:3053 31ST AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-2724
Practice Address - Country:US
Practice Address - Phone:206-915-7870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist