Provider Demographics
NPI:1871899526
Name:SAKCHALATHORN, JENNIFER ANNE (LMP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:SAKCHALATHORN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6865 HOLLY PARK DR S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3501
Mailing Address - Country:US
Mailing Address - Phone:206-669-8110
Mailing Address - Fax:
Practice Address - Street 1:6865 HOLLY PARK DR S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3501
Practice Address - Country:US
Practice Address - Phone:206-669-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60199225225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist