Provider Demographics
NPI:1134445786
Name:SPRAGUE, JESSICA ANN (LAC, LMP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:LAC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 NE 92ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2722
Mailing Address - Country:US
Mailing Address - Phone:206-947-2134
Mailing Address - Fax:
Practice Address - Street 1:5343 TALLMAN AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3931
Practice Address - Country:US
Practice Address - Phone:206-947-2134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60024371171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist