Provider Demographics
NPI:1376921056
Name:OLSON, JESSICA (LMT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S ARTHUR ST STE 425
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2266
Mailing Address - Country:US
Mailing Address - Phone:509-294-2987
Mailing Address - Fax:206-260-1357
Practice Address - Street 1:140 S ARTHUR ST STE 425
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2266
Practice Address - Country:US
Practice Address - Phone:509-294-2987
Practice Address - Fax:206-260-1357
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1376921056225700000X
WAMA60383814225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist