Provider Demographics
NPI:1295042026
Name:LINDBO, JESSICA J (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:J
Last Name:LINDBO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:J
Other - Last Name:JARAMILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:23817 109TH ST. CT. E.
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321
Mailing Address - Country:US
Mailing Address - Phone:253-209-8535
Mailing Address - Fax:253-845-5811
Practice Address - Street 1:16515 MERIDIAN AVE E SUITE 103B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375
Practice Address - Country:US
Practice Address - Phone:253-777-2691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60169681172M00000X
WAMA6011696811225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist