Provider Demographics
NPI:1740327220
Name:WEATHERMAN, JESSICA L (LMP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:WEATHERMAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:SEAGREAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1113 E WESTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1319
Mailing Address - Country:US
Mailing Address - Phone:509-465-8400
Mailing Address - Fax:209-465-8500
Practice Address - Street 1:1113 E WESTVIEW CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1319
Practice Address - Country:US
Practice Address - Phone:509-465-8400
Practice Address - Fax:209-465-8500
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020888225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist