Provider Demographics
NPI:1336219542
Name:JOHNSON, JENNIFER NOEL (LMP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NOEL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NOEL
Other - Last Name:COMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1666 E OLIVE WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5627
Mailing Address - Country:US
Mailing Address - Phone:206-323-1666
Mailing Address - Fax:206-323-6639
Practice Address - Street 1:1666 E OLIVE WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5627
Practice Address - Country:US
Practice Address - Phone:206-323-1666
Practice Address - Fax:206-323-6639
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016452225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist