Provider Demographics
NPI:1366634982
Name:CRUTCHLEY, JESSICA MICHELLE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MICHELLE
Last Name:CRUTCHLEY
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:PO BOX 2209
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-2209
Mailing Address - Country:US
Mailing Address - Phone:425-745-1121
Mailing Address - Fax:
Practice Address - Street 1:3328 167TH PL SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3228
Practice Address - Country:US
Practice Address - Phone:425-745-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024612225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist