Provider Demographics
NPI:1952482499
Name:LESLIE, JANA LAMEZ (LMP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:LAMEZ
Last Name:LESLIE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:LAMEZ
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2403 W LYNN STREET
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199
Mailing Address - Country:US
Mailing Address - Phone:206-605-1683
Mailing Address - Fax:
Practice Address - Street 1:3320 WEST MCGRAW ST
Practice Address - Street 2:UNRAVEL THERAPUTICS
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199
Practice Address - Country:US
Practice Address - Phone:206-283-9910
Practice Address - Fax:206-283-9935
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011771225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist