Provider Demographics
NPI:1487925921
Name:AUCKLY, JESSICA RENEE (EAMP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:AUCKLY
Suffix:
Gender:F
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 BOYLSTON AVE E
Mailing Address - Street 2:2
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3160
Mailing Address - Country:US
Mailing Address - Phone:206-399-5376
Mailing Address - Fax:
Practice Address - Street 1:340 15TH AVE E
Practice Address - Street 2:SUITE 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5808
Practice Address - Country:US
Practice Address - Phone:206-399-5376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60262222171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist