Provider Demographics
NPI:1679666846
Name:MAYER, JESSICA JEAN (LMP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JEAN
Last Name:MAYER
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 1:123 NW 100TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-4907
Mailing Address - Country:US
Mailing Address - Phone:206-550-0094
Mailing Address - Fax:206-624-9935
Practice Address - Street 1:200 NW BOWDOIN PL
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4941
Practice Address - Country:US
Practice Address - Phone:206-550-0094
Practice Address - Fax:206-624-9935
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016480225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist