MEDICARE: JENNIFER MOON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula	BD61677032	WA

General Provider Information

NPI Number	:	1528590791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MOON

Provider Business Mailing Address
First Line	:	14205 SE 36TH ST STE 100
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98006-1553
Country	:	US
Telephone Number	:	646-479-4725
Fax Number	:

Provider Business Practice Location Address
First Line	:	14205 SE 36TH ST STE 100-288
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98006-1596
Country	:	US
Telephone Number	:	646-479-4725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2017
Last Update Date	:	05/08/2026

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Directions to “ JENNIFER MOON ” Practice Location

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