Provider Demographics
NPI:1821490905
Name:SILVER, JEN LYNN (LMP, CCT)
Entity Type:Individual
Prefix:
First Name:JEN
Middle Name:LYNN
Last Name:SILVER
Suffix:
Gender:F
Credentials:LMP, CCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902
Mailing Address - Country:US
Mailing Address - Phone:509-969-2713
Mailing Address - Fax:
Practice Address - Street 1:3512 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-969-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-20
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60493060225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist