Provider Demographics
NPI:1942356704
Name:FREY, JEAN CONSTANCE (LM)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:CONSTANCE
Last Name:FREY
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 PACIFIC AVE. SE AROUND THE CIRCLE MIDWIFERY
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4753
Mailing Address - Country:US
Mailing Address - Phone:360-459-7222
Mailing Address - Fax:360-459-7223
Practice Address - Street 1:2120 PACIFIC AVE. SE AROUND THE CIRCLE MIDWIFERY
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4753
Practice Address - Country:US
Practice Address - Phone:360-459-7222
Practice Address - Fax:360-459-7223
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000262207V00000X
WAMW262176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8440893Medicaid
WA7109655Medicaid