Provider Demographics
NPI:1184813271
Name:MARTENS, JESSICA L (LAC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:MARTENS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2411 PACIFIC AVE SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2048
Mailing Address - Country:US
Mailing Address - Phone:360-870-4006
Mailing Address - Fax:888-972-6238
Practice Address - Street 1:2411 PACIFIC AVE SE
Practice Address - Street 2:SUITE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2048
Practice Address - Country:US
Practice Address - Phone:360-870-4006
Practice Address - Fax:888-972-6238
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002924171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist