Provider Demographics
NPI:1104164193
Name:KRACK, JENNIFER KAY (LMT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KAY
Last Name:KRACK
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 1:119 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2548
Mailing Address - Country:US
Mailing Address - Phone:406-863-9493
Mailing Address - Fax:406-863-9493
Practice Address - Street 1:119 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2548
Practice Address - Country:US
Practice Address - Phone:406-863-9493
Practice Address - Fax:406-863-9493
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1056 MASSAGE THERAPY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist