Jessie Jade Paque

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

24373 Highway 112 Ste 2
Clallam Bay, WA 98326-9606

Phone

(360) 640-8127

NPI assigned

Nov 15, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jessie Jade Jimmicum Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Klallam Counseling Services

  • Case Management Agency
  • Port Angeles, WA
  • NPI 1578890760
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683504000000",
    "number": "1972804441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1026 EAST FIRST STREET",
            "address_2": "SUITE 2",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "98362",
            "telephone_number": "360-452-4432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24373 HIGHWAY 112 STE 2",
            "city": "CLALLAM BAY",
            "state": "WA",
            "postal_code": "983269606",
            "telephone_number": "360-640-8127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAQUE",
        "first_name": "JESSIE",
        "middle_name": "JADE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-15",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSIE",
            "last_name": "JIMMICUM",
            "middle_name": "JADE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Clallam County Fire District 5
• Clallam County Public Hospital District No 1
• Thomas Ira Hughes, PA-C, MPAS
• Tanya Jean Hull
• Monique Ariel Peterson
• Rachelle Anne Riepe, D.M.D.
• Washington State Department of Corrections Clallam Bay Corrections Cen
• Wei Wu Weller

• All providers in Clallam Bay, WA
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.