Individual
JENNIFER JONES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
2004 BROADWAY ST, VANCOUVER, WA 98663-3327
(360) 993-8868
Mailing address
7012 NE 31ST AVE, VANCOUVER, WA 98665-0605
(360) 694-8940
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MAOOO16354
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
176456
LABOR AND INDUSTRIES
WA
01
—
860589
LIABILITY INSURANCE
WA
01
—
JONESJM394PN
DRIVER'S LICENSE
WA
01
—
MAOOO16354
MASSAGE LICENSE
WA
Enumeration date
03/19/2007
Last updated
07/08/2007
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