Provider Demographics
NPI:1255224960
Name:JACKSON, STEVEN JOHN (LMT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOHN
Last Name:JACKSON
Suffix:
Gender:M
Credentials:LMT
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 887
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:WA
Mailing Address - Zip Code:99347-0887
Mailing Address - Country:US
Mailing Address - Phone:509-844-5071
Mailing Address - Fax:
Practice Address - Street 1:256 13TH ST
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:WA
Practice Address - Zip Code:99347-1301
Practice Address - Country:US
Practice Address - Phone:509-844-8189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61679087225700000X
ID2171967225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist