Provider Demographics
NPI:1740062512
Name:MCKEE, JENNIFER D (CMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:MCKEE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12311 CHANDLER BLVD APT 37
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-4338
Mailing Address - Country:US
Mailing Address - Phone:310-982-3648
Mailing Address - Fax:
Practice Address - Street 1:5644 VINELAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2028
Practice Address - Country:US
Practice Address - Phone:310-982-3648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94489225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty