Healthcare Provider Details

I. General information

NPI: 1902130420
Provider Name (Legal Business Name): MELISSA JEPSEN JOHNS LMP, LMT, CR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16508 NE 101ST ST
VANCOUVER WA
98682-1743
US

IV. Provider business mailing address

16508 NE 101ST ST
VANCOUVER WA
98682-1743
US

V. Phone/Fax

Practice location:
  • Phone: 360-903-5863
  • Fax:
Mailing address:
  • Phone: 360-903-5863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60109474
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number16566
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: