Provider Demographics
NPI:1548405806
Name:WRIGHT, JEANNIE S (LMP, CYI)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:S
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LMP, CYI
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:S
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP, CYI
Mailing Address - Street 1:1019 NE PERKINS WAY
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-2261
Mailing Address - Country:US
Mailing Address - Phone:206-302-9637
Mailing Address - Fax:
Practice Address - Street 1:10021 HOLMAN RD NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98177-4920
Practice Address - Country:US
Practice Address - Phone:206-632-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
WAMA 60425265225700000X
COMT 0007629225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist