Provider Demographics
NPI:1053961128
Name:JENNESS, JAYME MARIE (MA 60364786)
Entity type:Individual
Prefix:
First Name:JAYME
Middle Name:MARIE
Last Name:JENNESS
Suffix:
Gender:F
Credentials:MA 60364786
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10403 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-1305
Mailing Address - Country:US
Mailing Address - Phone:360-627-0516
Mailing Address - Fax:
Practice Address - Street 1:10242 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-1432
Practice Address - Country:US
Practice Address - Phone:206-764-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60364786225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist