Healthcare Provider Details

I. General information

NPI: 1669719787
Provider Name (Legal Business Name): JENNIFER LYNN MORGAN L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 NE HICKMAN CT STE 1
PULLMAN WA
99163-5617
US

IV. Provider business mailing address

1230 NE HICKMAN CT STE 1
PULLMAN WA
99163-5617
US

V. Phone/Fax

Practice location:
  • Phone: 509-432-5053
  • Fax:
Mailing address:
  • Phone: 509-280-0939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60230282
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: