Provider Demographics
NPI:1356671440
Name:LINSTAD, JENNIFER L (MSM, LM, CPM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:LINSTAD
Suffix:
Gender:F
Credentials:MSM, LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 S MEAD ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2810
Mailing Address - Country:US
Mailing Address - Phone:206-712-7352
Mailing Address - Fax:
Practice Address - Street 1:4704 S MEAD ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2810
Practice Address - Country:US
Practice Address - Phone:206-712-7352
Practice Address - Fax:888-435-9983
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60498363176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1Medicaid
WA2OtherPRIVATE INSURANCE