Individual
JACKI L MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
10519 20TH ST. SE, SUITE # 1, LAKE STEVENS, WA 98258
(425) 397-4900
(425) 397-6900
Mailing address
P.O. BOX 1061, LAKE STEVENS, WA 98258
(425) 397-4900
(425) 397-6900
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00004663
WA
Other
Enumeration date
06/18/2007
Last updated
02/02/2021
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