Provider Demographics
NPI:1548404809
Name:JADE TREE HOLISTIC HEALTH LLC
Entity Type:Organization
Organization Name:JADE TREE HOLISTIC HEALTH LLC
Other - Org Name:JADE TREE MASSAGE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED MASSAGE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:DROST
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-414-0152
Mailing Address - Street 1:16904 JUANITA DR NE # 172
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4248
Mailing Address - Country:US
Mailing Address - Phone:206-414-0152
Mailing Address - Fax:
Practice Address - Street 1:19110 BOTHELL WAY NE STE 103
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2970
Practice Address - Country:US
Practice Address - Phone:206-414-0152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2010-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60088384225700000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty