Provider Demographics
NPI:1487990925
Name:WATSON, JENNIFER JO (LMP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JO
Last Name:WATSON
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 1:22300 SUNRIDGE WAY NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7789
Mailing Address - Country:US
Mailing Address - Phone:360-531-0561
Mailing Address - Fax:
Practice Address - Street 1:123 BJUNE DR SE
Practice Address - Street 2:SUITE 111
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2459
Practice Address - Country:US
Practice Address - Phone:360-531-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-01
Last Update Date:2013-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00017221225700000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula