Provider Demographics
NPI:1003039397
Name:REEVE, JOANNA KATHERINE (LMP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:KATHERINE
Last Name:REEVE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10135 NE 112TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-4458
Mailing Address - Country:US
Mailing Address - Phone:206-227-0058
Mailing Address - Fax:425-576-1110
Practice Address - Street 1:10135 NE 112TH PL
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-4458
Practice Address - Country:US
Practice Address - Phone:206-227-0058
Practice Address - Fax:425-576-1110
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019883174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist