Provider Demographics
NPI:1023166238
Name:ANDERSON, JENNIFER MARIE (LMP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:ANDERSON
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 1:8320 LAKE CITY WAY NE
Mailing Address - Street 2:#106
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4414
Mailing Address - Country:US
Mailing Address - Phone:425-652-2207
Mailing Address - Fax:
Practice Address - Street 1:8320 LAKE CITY WAY NE
Practice Address - Street 2:#106
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4414
Practice Address - Country:US
Practice Address - Phone:425-652-2207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist