Provider Demographics
NPI:1063753507
Name:JCKOWSKI, JAMI LEE (LMT)
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:LEE
Last Name:JCKOWSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15202 PONDEROSA LOOP
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-8948
Mailing Address - Country:US
Mailing Address - Phone:541-977-7309
Mailing Address - Fax:
Practice Address - Street 1:15202 PONDEROSA LOOP
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-8948
Practice Address - Country:US
Practice Address - Phone:541-977-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist