Provider Demographics
NPI:1629479738
Name:JAKLITSCH, LYNDZEE (LICENSED MASSAGE THE)
Entity Type:Individual
Prefix:
First Name:LYNDZEE
Middle Name:
Last Name:JAKLITSCH
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:LYNDZEE
Other - Middle Name:
Other - Last Name:DONOHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSED MASSAGE THE
Mailing Address - Street 1:806 SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942
Mailing Address - Country:US
Mailing Address - Phone:509-952-6264
Mailing Address - Fax:
Practice Address - Street 1:2807 W. WASHINGTON AVE
Practice Address - Street 2:SUITE B, ROOM #223
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903
Practice Address - Country:US
Practice Address - Phone:509-952-6264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60483555225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0330414OtherLABOR AND INDUSTRIES