Provider Demographics
NPI:1427006204
Name:HERD, JEFFREY M (LMP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:HERD
Suffix:
Gender:M
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 431
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-0431
Mailing Address - Country:US
Mailing Address - Phone:360-904-2774
Mailing Address - Fax:360-695-5598
Practice Address - Street 1:606 N DEVINE RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6961
Practice Address - Country:US
Practice Address - Phone:360-904-2774
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA14163225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist