Provider Demographics
NPI:1376688747
Name:SOAMES, JENNIFER (LMP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SOAMES
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 1:12932 SE KENT KANGLEY RD
Mailing Address - Street 2:#438
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7940
Mailing Address - Country:US
Mailing Address - Phone:425-392-1814
Mailing Address - Fax:425-392-1813
Practice Address - Street 1:23925 225TH WAY SE
Practice Address - Street 2:SUITE B
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5233
Practice Address - Country:US
Practice Address - Phone:425-433-0760
Practice Address - Fax:425-433-0733
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022636225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0215154OtherDEPT OF L&I