Provider Demographics
NPI:1124296025
Name:COONS, JANN YVONNE (LMP)
Entity type:Individual
Prefix:MS
First Name:JANN
Middle Name:YVONNE
Last Name:COONS
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 1:2463 WOODS RD E
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-8309
Mailing Address - Country:US
Mailing Address - Phone:206-349-6404
Mailing Address - Fax:
Practice Address - Street 1:3272 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3375
Practice Address - Country:US
Practice Address - Phone:206-349-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012242225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0211042OtherL & I
WAMA00012242OtherDEPT OF HEALTH