Individual
MRS. JACLYN JUNE MONGE SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4520 INTELCO LOOP SE BLDG 3, LACEY, WA 98503-6008
(360) 388-0485
(360) 890-4066
Mailing address
9649 LOOKOUT DR NW, OLYMPIA, WA 98502-9757
(360) 388-0485
(360) 890-4066
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MA00023326
WA
Other
Enumeration date
11/16/2007
Last updated
11/22/2020
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