Individual
JENNIFER COULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4315 MCKINLEY ST NE, LACEY, WA 98516-6281
(360) 868-7005
Mailing address
4315 MCKINLEY ST NE, LACEY, WA 98516-6281
(360) 868-7005
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
60666372
WA
Other
Enumeration date
09/17/2016
Last updated
09/17/2016
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