Provider Demographics
NPI:1013130095
Name:BAUER, JEANETTE (LMP)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 AURORA AVE NORTH
Mailing Address - Street 2:SUITE 216
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7853
Mailing Address - Country:US
Mailing Address - Phone:206-715-4671
Mailing Address - Fax:
Practice Address - Street 1:4000 AURORA AVE NORTH
Practice Address - Street 2:SUITE 216
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7853
Practice Address - Country:US
Practice Address - Phone:206-715-4671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011045225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA81-1673514OtherEIN