Provider Demographics
NPI:1922132448
Name:MCCOLLUM, JENNIFER A (ND)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 N 147TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6707
Mailing Address - Country:US
Mailing Address - Phone:206-362-1346
Mailing Address - Fax:
Practice Address - Street 1:1800 SW 152ND ST
Practice Address - Street 2:SUITE 203A
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1700
Practice Address - Country:US
Practice Address - Phone:206-838-3878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001190175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath