Provider Demographics
NPI:1275825671
Name:MUNSON, JENNIFER VANESSA (LMP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:VANESSA
Last Name:MUNSON
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 1:3423 LAKE LANGLOIS RD NE
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-6007
Mailing Address - Country:US
Mailing Address - Phone:425-333-4347
Mailing Address - Fax:
Practice Address - Street 1:23515 NORTHEAST NOVELTY HILL ROAD
Practice Address - Street 2:#225
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053
Practice Address - Country:US
Practice Address - Phone:425-898-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60180410225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist