Provider Demographics
NPI:1689839789
Name:DUERR, JESSICA MICHEL (LMP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MICHEL
Last Name:DUERR
Suffix:
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 1:619 SW 152ND ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2212
Mailing Address - Country:US
Mailing Address - Phone:206-242-0998
Mailing Address - Fax:206-244-3962
Practice Address - Street 1:619 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2212
Practice Address - Country:US
Practice Address - Phone:206-242-0998
Practice Address - Fax:206-244-3962
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021493225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00021493OtherLICENSE NUMBER