Provider Demographics
NPI:1629718390
Name:WESTBY, REYNI JADE (LAC)
Entity Type:Individual
Prefix:
First Name:REYNI
Middle Name:JADE
Last Name:WESTBY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:REANNAH
Other - Middle Name:JANE
Other - Last Name:KLASSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3015 WILDERNESS LOOP SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4991
Mailing Address - Country:US
Mailing Address - Phone:425-495-0004
Mailing Address - Fax:
Practice Address - Street 1:128 D ST SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4064
Practice Address - Country:US
Practice Address - Phone:360-570-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC208574171100000X
WAAC61295888171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty