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General NPI Number Information
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NPI Number | 1629123997
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Entity Type | Individual
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Provider Name | JESSICA RAE CROFOOT LMP
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 12737 BEL RED RD STE 210
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City | BELLEVUE
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State | WA
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Zip | 98005-2697
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Country | US
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Telephone | 425-885-5581
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Fax | 877-271-2511
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Provider Business Mailing Address
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Address Line | 12737 BEL RED RD STE 210
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City | BELLEVUE
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State | WA
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Zip | 98005-2697
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Country | US
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Telephone | 425-829-1205
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Fax | 877-271-2511
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00022713
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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License Number | RF 60480656
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License Number State | WA
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