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General NPI Number Information
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NPI Number | 1508681958
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Entity Type | Individual
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Provider Name | JENNIFER GRACE RIEKEN MA61494004
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Gender | Female
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 630 N CHELAN AVE
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City | WENATCHEE
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State | WA
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Zip | 98801-6622
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Country | US
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Telephone | 509-665-8363
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Fax |
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Provider Business Mailing Address
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Address Line | 9606 19TH AVE SE # 14
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City | EVERETT
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State | WA
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Zip | 98208-3805
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Country | US
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Telephone | 425-870-4978
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA61494004
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License Number State | WA
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