Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60145637 | WA |
NPI | 1003133851 |
---|---|
Provider Name | Miss Jennifer Allred |
First Address | Vancouver, WA 98684-3017 |
Second Address | Vancouver, WA 98684-3017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2010 |
Last Update Date | 03/05/2010 |