Provider Demographics
NPI:1598834772
Name:KIER, JENNIFER BETH I (LMP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BETH
Last Name:KIER
Suffix:I
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 1:3780 GILMORE RD
Mailing Address - Street 2:
Mailing Address - City:EVERSON
Mailing Address - State:WA
Mailing Address - Zip Code:98247-9452
Mailing Address - Country:US
Mailing Address - Phone:360-966-0200
Mailing Address - Fax:
Practice Address - Street 1:3780 GILMORE RD
Practice Address - Street 2:
Practice Address - City:EVERSON
Practice Address - State:WA
Practice Address - Zip Code:98247-9452
Practice Address - Country:US
Practice Address - Phone:360-966-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018697225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5554KIOtherREGENCE PROVIDERID