Provider Demographics
NPI:1639429418
Name:LEVY, JAIME KATHLEEN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:KATHLEEN
Last Name:LEVY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:KATHLEEN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-0115
Mailing Address - Country:US
Mailing Address - Phone:509-881-7905
Mailing Address - Fax:
Practice Address - Street 1:527 MOUNTAIN VIEW DR
Practice Address - Street 2:UNIT B
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-5002
Practice Address - Country:US
Practice Address - Phone:509-881-7905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60040600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist