Provider Demographics
NPI:1780735498
Name:JAFFE, CYNTHIA BETH (LM)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:BETH
Last Name:JAFFE
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:GREENBANK
Mailing Address - State:WA
Mailing Address - Zip Code:98253-0067
Mailing Address - Country:US
Mailing Address - Phone:360-678-3594
Mailing Address - Fax:360-678-3783
Practice Address - Street 1:3455 OLD COUNTY ROAD
Practice Address - Street 2:
Practice Address - City:GREENBANK
Practice Address - State:WA
Practice Address - Zip Code:98253-0067
Practice Address - Country:US
Practice Address - Phone:360-678-3594
Practice Address - Fax:360-678-3783
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000126176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7047590Medicaid
WA7036155Medicaid