Provider Demographics
NPI:1699381392
Name:WASHBURN, JEANNA (LMT)
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WILKES ST STE 103
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-2125
Mailing Address - Country:US
Mailing Address - Phone:970-231-4154
Mailing Address - Fax:
Practice Address - Street 1:215 WILKES ST STE 103
Practice Address - Street 2:
Practice Address - City:STEILACOOM
Practice Address - State:WA
Practice Address - Zip Code:98388-2125
Practice Address - Country:US
Practice Address - Phone:253-248-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60995836225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist