Healthcare Provider Details

I. General information

NPI: 1831471358
Provider Name (Legal Business Name): JENNIFER A BLASI N.D. LAC EAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2011
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 116TH AVE NE STE 205
BELLEVUE WA
98004-3811
US

IV. Provider business mailing address

1515 116TH AVE NE STE 205
BELLEVUE WA
98004-3811
US

V. Phone/Fax

Practice location:
  • Phone: 206-618-6549
  • Fax: 425-375-0302
Mailing address:
  • Phone: 206-618-6549
  • Fax: 425-375-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60242287
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60252797
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: