Provider Demographics
NPI:1215200787
Name:HANNAM, JAMIE LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:HANNAM
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:PO BOX 12621
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98082-0621
Mailing Address - Country:US
Mailing Address - Phone:425-773-8352
Mailing Address - Fax:
Practice Address - Street 1:11314 4TH AVE W
Practice Address - Street 2:SUITE #103
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6926
Practice Address - Country:US
Practice Address - Phone:425-355-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60166182225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist