Provider Demographics
NPI:1093910465
Name:FORSHAW, JEANNE KAYE (LMP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:KAYE
Last Name:FORSHAW
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 1:3000 RUBY CT SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2313
Mailing Address - Country:US
Mailing Address - Phone:360-895-3231
Mailing Address - Fax:
Practice Address - Street 1:2427 BETHEL RD SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2438
Practice Address - Country:US
Practice Address - Phone:360-874-2727
Practice Address - Fax:360-874-7952
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014436225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA142678OtherLABOR AND INDUSTRY