Provider Demographics
NPI:1508631409
Name:MENCOS-CANTE, JACKELINE ANDREA
Entity Type:Individual
Prefix:
First Name:JACKELINE
Middle Name:ANDREA
Last Name:MENCOS-CANTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33422 192ND AVE SE UNIT 54
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-2267
Mailing Address - Country:US
Mailing Address - Phone:206-451-9292
Mailing Address - Fax:
Practice Address - Street 1:2317 SW 320TH ST STE 3
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2567
Practice Address - Country:US
Practice Address - Phone:253-839-9330
Practice Address - Fax:253-839-9330
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist