Provider Demographics
NPI:1932416906
Name:BRISCOE, JODI LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8704 19TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3520
Mailing Address - Country:US
Mailing Address - Phone:206-280-0113
Mailing Address - Fax:
Practice Address - Street 1:3209 W MCGRAW ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-3207
Practice Address - Country:US
Practice Address - Phone:206-281-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60083607174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist