Provider Demographics
NPI:1871787945
Name:SPENCER, JESSICA ROSE HERRERO (LMP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA ROSE
Middle Name:HERRERO
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1416 HEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3503
Mailing Address - Country:US
Mailing Address - Phone:425-252-8939
Mailing Address - Fax:425-252-5209
Practice Address - Street 1:1416 HEWITT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3503
Practice Address - Country:US
Practice Address - Phone:425-252-8939
Practice Address - Fax:425-252-5209
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022769225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist