Provider Demographics
NPI:1235497470
Name:JORDAN, JOLYNN (LMP)
Entity Type:Individual
Prefix:
First Name:JOLYNN
Middle Name:
Last Name:JORDAN
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 2394
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0108
Mailing Address - Country:US
Mailing Address - Phone:206-501-5646
Mailing Address - Fax:206-659-0776
Practice Address - Street 1:778 N 73RD ST
Practice Address - Street 2:#2
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-5150
Practice Address - Country:US
Practice Address - Phone:206-501-5646
Practice Address - Fax:206-659-0776
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019074225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist