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General NPI Number Information
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NPI Number | 1831042522
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Entity Type | Individual
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Provider Name | KATELYN GRACE JESIENOUSKI
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Gender | Female
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Dates
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Enumeration Date | 02/20/2026
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 23403 E MISSION AVE STE 228
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-5113
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Country | US
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Telephone | 509-645-2721
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 N ETTA CT
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-9520
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Country | US
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Telephone | 509-645-2721
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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 | MA7008643
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License Number State | WA
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