Provider Demographics
NPI:1689075848
Name:LEMON, JACQUELINE R I (LMP)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:R
Last Name:LEMON
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 1:126 NW HOMEWARD AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:WA
Mailing Address - Zip Code:98648-6639
Mailing Address - Country:US
Mailing Address - Phone:360-597-8577
Mailing Address - Fax:
Practice Address - Street 1:12214 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6019
Practice Address - Country:US
Practice Address - Phone:360-944-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60486698171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor