Individual
JODY LYN GENUARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NC10062045
Contact information
Practice address
9330 59TH AVE SW, LAKEWOOD, WA 98499-2858
(253) 298-9141
Mailing address
9330 59TH AVENUE SOUTHWEST, LAKEWOOD, WA 98499
(253) 298-9141
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
NC 10062045
WA
Other
Enumeration date
10/18/2012
Last updated
10/18/2012
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