Healthcare Provider Details

I. General information

NPI: 1306750328
Provider Name (Legal Business Name): JADA FAWN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 W MCGRAW ST STE 4
SEATTLE WA
98199-3241
US

IV. Provider business mailing address

3320 W MCGRAW ST STE 4
SEATTLE WA
98199-3241
US

V. Phone/Fax

Practice location:
  • Phone: 206-283-9910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70180378
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: