Provider Demographics
NPI:1295907947
Name:SEWELL, JENNIFER MARIE (LMP MA00015044)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:SEWELL
Suffix:
Gender:F
Credentials:LMP MA00015044
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BICKFORD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290
Mailing Address - Country:US
Mailing Address - Phone:425-319-1123
Mailing Address - Fax:360-863-2649
Practice Address - Street 1:1800 BICKFORD AVE STE 201
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290
Practice Address - Country:US
Practice Address - Phone:425-319-1123
Practice Address - Fax:360-863-2649
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015044225700000X
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist