Provider Demographics
NPI:1932424777
Name:JARDINE, LYNN ANN (LMP, LRCP, CC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:JARDINE
Suffix:
Gender:F
Credentials:LMP, LRCP, CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 NW 195TH ST
Mailing Address - Street 2:#6
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2860
Mailing Address - Country:US
Mailing Address - Phone:206-801-7297
Mailing Address - Fax:
Practice Address - Street 1:18405 AURORA AVE N SUITE H #105
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133
Practice Address - Country:US
Practice Address - Phone:206-801-7297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL 60160469101YP1600X
WAMA 00003241225700000X
WALR 00000879227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified