MEDICARE: MS. JENNIFER RION REARDON LMP

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	174400000X	Specialist	MA00013990	WA

General Provider Information

NPI Number	:	1538210315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER RION REARDON LMP

Provider Business Mailing Address
First Line	:	5003 240TH PL SW
Second Line	:
City	:	MOUNTLAKE TERRACE
State	:	WA
Zip	:	98043-5628
Country	:	US
Telephone Number	:	206-290-0106
Fax Number	:

Provider Business Practice Location Address
First Line	:	5003 240TH PL SW
Second Line	:
City	:	MOUNTLAKE TERRACE
State	:	WA
Zip	:	98043-5628
Country	:	US
Telephone Number	:	206-290-0106
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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