Provider Demographics
NPI:1215229216
Name:LEE, JILLIAN BRIANNA (LMP)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:BRIANNA
Last Name:LEE
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 1:500 S PINES RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5324
Mailing Address - Country:US
Mailing Address - Phone:509-927-8881
Mailing Address - Fax:509-891-6281
Practice Address - Street 1:500 S PINES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5324
Practice Address - Country:US
Practice Address - Phone:509-927-8881
Practice Address - Fax:509-891-6281
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60212950225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist