Individual
MS. JENNIFER KONOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
55 HONER LOOP, CRESWELL, OR 97426-9899
(541) 868-4917
Mailing address
55 HONER LOOP, CRESWELL, OR 97426-9899
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11402
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215177936
MASSAGE THERAPY
—
Enumeration date
02/21/2009
Last updated
03/15/2009
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