Provider Demographics
NPI:1356055214
Name:STENERSEN, JAELENE (LMP)
Entity type:Individual
Prefix:
First Name:JAELENE
Middle Name:
Last Name:STENERSEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 W 27TH AVE STE E
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1986
Mailing Address - Country:US
Mailing Address - Phone:509-783-0834
Mailing Address - Fax:509-987-1090
Practice Address - Street 1:4303 W 27TH AVE STE E
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-1986
Practice Address - Country:US
Practice Address - Phone:509-783-0834
Practice Address - Fax:509-987-1090
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61372248225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist