Provider Demographics
NPI:1740515907
Name:GREENBERG, JESSICA TIMINS (LAC, EAMP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:TIMINS
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:TIMINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, EAMP
Mailing Address - Street 1:105 NE 56TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3737
Mailing Address - Country:US
Mailing Address - Phone:206-618-5902
Mailing Address - Fax:
Practice Address - Street 1:105 NE 56TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3737
Practice Address - Country:US
Practice Address - Phone:206-618-5902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60113868171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist