Provider Demographics
NPI:1023152139
Name:SIMPSON, JERI A (LMP)
Entity type:Individual
Prefix:MRS
First Name:JERI
Middle Name:A
Last Name:SIMPSON
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 1:640 VAN DE VANTER AVE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6210
Mailing Address - Country:US
Mailing Address - Phone:253-852-5997
Mailing Address - Fax:
Practice Address - Street 1:640 VAN DE VANTER AVE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6210
Practice Address - Country:US
Practice Address - Phone:253-852-5997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019893225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist