Provider Demographics
NPI:1265631717
Name:HANNING, JESSICA MARGARET
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARGARET
Last Name:HANNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARGARET
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3627 WHEATON WAY STE 105A
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3510
Mailing Address - Country:US
Mailing Address - Phone:360-377-3601
Mailing Address - Fax:
Practice Address - Street 1:3627 WHEATON WAY STE 105A
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3510
Practice Address - Country:US
Practice Address - Phone:360-377-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-15
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024249225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist