Provider Demographics
NPI:1013239623
Name:AGARD, JANE ANN
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ANN
Last Name:AGARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9541
Mailing Address - Country:US
Mailing Address - Phone:360-961-5568
Mailing Address - Fax:360-595-2393
Practice Address - Street 1:1155 N STATE ST
Practice Address - Street 2:SUITE 325
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5037
Practice Address - Country:US
Practice Address - Phone:360-961-5568
Practice Address - Fax:360-595-2393
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60132964225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist