Provider Demographics
NPI:1831471358
Name:BLASI, JENNIFER A (ND LAC EAMP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:BLASI
Suffix:
Gender:F
Credentials:ND LAC EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 140TH AVE NE UNIT E102
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-6929
Mailing Address - Country:US
Mailing Address - Phone:206-618-6549
Mailing Address - Fax:425-968-6367
Practice Address - Street 1:17000 140TH AVE NE UNIT E102
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6929
Practice Address - Country:US
Practice Address - Phone:206-618-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-10
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60252797171100000X
WANT60242287175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist