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General NPI Number Information
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NPI Number | 1053703678
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Entity Type | Organization
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Legal Business Name | MASSAGE BY JENNI
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 9013 NE HIGHWAY 99
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City | VANCOUVER
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State | WA
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Zip | 98665-8942
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Country | US
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Telephone | 360-904-0419
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Fax |
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Provider Business Mailing Address
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Address Line | 13015 NE 406TH ST
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City | AMBOY
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State | WA
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Zip | 98601-3513
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Country | US
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Telephone | 360-904-0419
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Fax |
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Authorized Official
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Title or Position | LMP
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Name | JENNIFER SOSKY
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Credential |
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Telephone | 360-904-0419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | MA 60334878
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License Number State | WA
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