Provider Demographics
NPI:1285859991
Name:LABELLE, JESSICA DIANE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DIANE
Last Name:LABELLE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:DIANE
Other - Last Name:CONNALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:33210 N SPOTTED RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-9521
Mailing Address - Country:US
Mailing Address - Phone:509-276-5324
Mailing Address - Fax:509-242-1854
Practice Address - Street 1:9720 N NEVADA ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-5019
Practice Address - Country:US
Practice Address - Phone:509-464-2273
Practice Address - Fax:509-242-1854
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023773225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00023773OtherLICENSE