Provider Demographics
NPI:1720470453
Name:MILLS, JENNIE (LMT, CCT, CD(DONA))
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:LMT, CCT, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 MILLS PL NE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-9440
Mailing Address - Country:US
Mailing Address - Phone:425-780-7208
Mailing Address - Fax:425-888-1273
Practice Address - Street 1:38579 SE RIVER ST
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-5155
Practice Address - Country:US
Practice Address - Phone:425-780-7208
Practice Address - Fax:425-888-1273
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60455117225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist