Provider Demographics
NPI:1851561146
Name:JENSEN, LACEY ANAMARIE (LMP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ANAMARIE
Last Name:JENSEN
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 1:1209 MAPLE ST APT 11
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-7537
Mailing Address - Country:US
Mailing Address - Phone:509-881-7909
Mailing Address - Fax:
Practice Address - Street 1:309 OKANOGAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2970
Practice Address - Country:US
Practice Address - Phone:509-881-7909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024233225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist