Provider Demographics
NPI:1780700278
Name:JEAN JEAN ENTERPRISES
Entity type:Organization
Organization Name:JEAN JEAN ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-675-1740
Mailing Address - Street 1:5355 TALLMAN AVE NW
Mailing Address - Street 2:#216
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107
Mailing Address - Country:US
Mailing Address - Phone:206-675-1740
Mailing Address - Fax:206-675-1043
Practice Address - Street 1:5355 TALLMAN AVE NW
Practice Address - Street 2:#216
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107
Practice Address - Country:US
Practice Address - Phone:206-675-1740
Practice Address - Fax:206-675-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006957225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACL5421OtherREGENCE INSURANCE CO