Healthcare Provider Details

I. General information

NPI: 1548404809
Provider Name (Legal Business Name): JADE TREE HOLISTIC HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 08/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19110 BOTHELL WAY NE STE 103
BOTHELL WA
98011-2970
US

IV. Provider business mailing address

16904 JUANITA DR NE # 172
KENMORE WA
98028-4248
US

V. Phone/Fax

Practice location:
  • Phone: 206-414-0152
  • Fax:
Mailing address:
  • Phone: 206-414-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60088384
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER JOANNE DROST
Title or Position: LICENSED MASSAGE PRACTITIONER
Credential: LMP
Phone: 206-414-0152