Provider Demographics
NPI:1265838726
Name:GROH, JENIFER (MA 60062993)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:GROH
Suffix:
Gender:F
Credentials:MA 60062993
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 50TH ST CT NW STE 204
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8587
Mailing Address - Country:US
Mailing Address - Phone:425-894-7946
Mailing Address - Fax:
Practice Address - Street 1:3214 50TH ST CT NW STE 204
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8587
Practice Address - Country:US
Practice Address - Phone:425-894-7946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60062993225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist