Provider Demographics
NPI:1457643421
Name:BONTEMPO, JESSICA (LMP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BONTEMPO
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 1:5325 116TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8706
Mailing Address - Country:US
Mailing Address - Phone:425-301-8947
Mailing Address - Fax:
Practice Address - Street 1:13033 NE 70TH PL
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8657
Practice Address - Country:US
Practice Address - Phone:425-301-8947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60201076225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist