Provider Demographics
NPI:1851720916
Name:WEATHERSEED, JESSICA ANNE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANNE
Last Name:WEATHERSEED
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:BUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:12302 219TH AVE. CT.E.
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391
Mailing Address - Country:US
Mailing Address - Phone:253-405-9803
Mailing Address - Fax:
Practice Address - Street 1:22015 STATE ROUTE 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-4241
Practice Address - Country:US
Practice Address - Phone:253-891-9109
Practice Address - Fax:253-826-0438
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60329055172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist