Provider Demographics
NPI:1255769436
Name:SWENSON, JARROD
Entity type:Individual
Prefix:
First Name:JARROD
Middle Name:
Last Name:SWENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11715 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4901
Mailing Address - Country:US
Mailing Address - Phone:206-819-4432
Mailing Address - Fax:
Practice Address - Street 1:1319 DEXTER AVE N
Practice Address - Street 2:#365
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3568
Practice Address - Country:US
Practice Address - Phone:206-819-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA.60378654225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist