Healthcare Provider Details

I. General information

NPI: 1134663198
Provider Name (Legal Business Name): JENNIFER ANDERS L.M.P., L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2016
Last Update Date: 12/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E HASTINGS RD
SPOKANE WA
99218-4901
US

IV. Provider business mailing address

9711 N INDIAN TRAIL RD
SPOKANE WA
99208-8300
US

V. Phone/Fax

Practice location:
  • Phone: 509-340-3303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60703334
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number20853
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: