Provider Demographics
NPI:1548597404
Name:HAGER, JODENE ANN (LMP)
Entity Type:Individual
Prefix:
First Name:JODENE
Middle Name:ANN
Last Name:HAGER
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 1:3728 BEACH DR SW APT 1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3061
Mailing Address - Country:US
Mailing Address - Phone:206-450-0925
Mailing Address - Fax:
Practice Address - Street 1:3728 BEACH DR SW APT 1
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3061
Practice Address - Country:US
Practice Address - Phone:206-450-0925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017630225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist