Individual
JENNIFER BROOKE CONLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
25720 MAPLE VALLEY BLACK DIAMOND RD SE, MAPLE VALLEY, WA 98038-8313
(425) 413-3400
Mailing address
25720 MAPLE VALLEY BLACK DIAMOND RD SE, MAPLE VALLEY, WA 98038-8313
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
P160465758
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P160465758
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
04/23/2018
Last updated
04/23/2018
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