Provider Demographics
NPI:1801966247
Name:WALKER, JENNIFER MARIE (LMP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:MOORHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1807 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9106
Mailing Address - Country:US
Mailing Address - Phone:253-370-6868
Mailing Address - Fax:
Practice Address - Street 1:5920 100TH ST SW STE 22
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2751
Practice Address - Country:US
Practice Address - Phone:253-581-1442
Practice Address - Fax:253-449-0564
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019236225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist