Healthcare Provider Details

I. General information

NPI: 1679688303
Provider Name (Legal Business Name): JENNIFER MCEWEN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 W CLEARWATER AVE #I
KENNEWICK WA
99336
US

IV. Provider business mailing address

PO BOX 6389
KENNEWICK WA
99336
US

V. Phone/Fax

Practice location:
  • Phone: 509-783-6677
  • Fax: 509-783-6675
Mailing address:
  • Phone: 509-851-1951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00017741
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA0017741
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: