Provider Demographics
NPI:1891002630
Name:STRATTON, JACQUELINE LEE (LMP,LM,)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LEE
Last Name:STRATTON
Suffix:
Gender:F
Credentials:LMP,LM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12746 10TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3917
Mailing Address - Country:US
Mailing Address - Phone:206-368-5655
Mailing Address - Fax:
Practice Address - Street 1:12746 10TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-3917
Practice Address - Country:US
Practice Address - Phone:206-368-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000071176B00000X
WAMA00000632174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7042260Medicaid