Healthcare Provider Details

I. General information

NPI: 1124707294
Provider Name (Legal Business Name): JENNIFER MARIE ENRIQUES LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BROADWAY ST
VANCOUVER WA
98663-3229
US

IV. Provider business mailing address

2400 BROADWAY ST
VANCOUVER WA
98663-3229
US

V. Phone/Fax

Practice location:
  • Phone: 360-868-7030
  • Fax:
Mailing address:
  • Phone: 360-868-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number60989884
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: