Provider Demographics
NPI:1467490821
Name:HOUGHTEN, JACQUELINE MAE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MAE
Last Name:HOUGHTEN
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 1:16909 NE 227TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606
Mailing Address - Country:US
Mailing Address - Phone:360-600-5022
Mailing Address - Fax:
Practice Address - Street 1:10501 NE HWY 99
Practice Address - Street 2:SUITE #23
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686
Practice Address - Country:US
Practice Address - Phone:360-573-9669
Practice Address - Fax:360-573-0448
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015213225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0160228OtherDEPT OF LABOR AND INDUST