Provider Demographics
NPI:1457826604
Name:MCGUIRE, JENNIFER LEEANN (LMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEEANN
Last Name:MCGUIRE
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 1:9525 186TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-5909
Mailing Address - Country:US
Mailing Address - Phone:757-634-8450
Mailing Address - Fax:
Practice Address - Street 1:16303 HIGHWAY 99 STE 1B
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-1453
Practice Address - Country:US
Practice Address - Phone:425-743-9460
Practice Address - Fax:425-743-9409
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60876996225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist