Provider Demographics
NPI:1376041335
Name:FRICKS-CULBREATH, JENE GABRIELLE (LMT)
Entity Type:Individual
Prefix:MS
First Name:JENE
Middle Name:GABRIELLE
Last Name:FRICKS-CULBREATH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15110 NE 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-1984
Mailing Address - Country:US
Mailing Address - Phone:360-624-4930
Mailing Address - Fax:
Practice Address - Street 1:15110 NE 72ND AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-1984
Practice Address - Country:US
Practice Address - Phone:360-624-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60823504225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist