Healthcare Provider Details

I. General information

NPI: 1497070478
Provider Name (Legal Business Name): JESSICA LYNN GOAD LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
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

4866 CASBERG-BURROUGHS RD.
DEER PARK WA
99006
US

V. Phone/Fax

Practice location:
  • Phone: 509-340-3303
  • Fax: 509-232-5550
Mailing address:
  • Phone: 509-710-6654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number60134348
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: