Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60898266 | WA |
NPI | 1013480268 |
---|---|
Provider Name | Jennifer Young |
First Address | Longview, WA 98632-4081 |
Second Address | Longview, WA 98632-4081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2019 |
Last Update Date | 09/01/2019 |