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General NPI Number Information
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NPI Number | 1801364237
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Entity Type | Individual
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Provider Name | JESSICA KATHERINE LIVOLSI SWEDISH CERTIFICATE
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Gender | Female
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Dates
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Enumeration Date | 11/03/2018
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Last Update Date | 11/03/2018
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Provider Practice Location Address
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Address Line | 5213 PACIFIC AVE
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City | TACOMA
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State | WA
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Zip | 98408-7695
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Country | US
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Telephone | 253-474-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 24304 78TH AVENUE CT E
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City | GRAHAM
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State | WA
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Zip | 98338-9388
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Country | US
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Telephone | 253-495-5530
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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 | 60894810
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License Number State | WA
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