Provider Demographics
NPI:1114130275
Name:DRAGOO, JENNIFER G (LMP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:G
Last Name:DRAGOO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:G
Other - Last Name:TURETZKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:P.O. BOX 1804
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020
Mailing Address - Country:US
Mailing Address - Phone:206-697-0178
Mailing Address - Fax:206-542-6725
Practice Address - Street 1:9631 FIRDALE AVE
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020
Practice Address - Country:US
Practice Address - Phone:206-697-0178
Practice Address - Fax:206-542-6725
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015140W225700000X
WAMA00015140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist