Provider Demographics
NPI:1295988459
Name:WOLFRUM, JESSICA DOLORES (LMP)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:DOLORES
Last Name:WOLFRUM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10121 EVERGREEN WAY
Mailing Address - Street 2:#25-244
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-3885
Mailing Address - Country:US
Mailing Address - Phone:425-374-2541
Mailing Address - Fax:425-374-2541
Practice Address - Street 1:16908 JUANITA DR NE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4248
Practice Address - Country:US
Practice Address - Phone:425-482-9273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60025082225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist