Provider Demographics
NPI:1326374489
Name:CROSSFIELD, JEMIMA VALENZUELA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JEMIMA
Middle Name:VALENZUELA
Last Name:CROSSFIELD
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:P.O. BOX 661
Mailing Address - Street 2:190 9TH STREET
Mailing Address - City:POMEROY
Mailing Address - State:WA
Mailing Address - Zip Code:99347-0661
Mailing Address - Country:US
Mailing Address - Phone:509-843-3830
Mailing Address - Fax:509-843-3830
Practice Address - Street 1:190 9TH STREET
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:WA
Practice Address - Zip Code:99347-0661
Practice Address - Country:US
Practice Address - Phone:509-843-3830
Practice Address - Fax:509-843-3830
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00012838225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist