Provider Demographics
NPI:1154408482
Name:HORN, JARRID DEAN (LMP)
Entity type:Individual
Prefix:MR
First Name:JARRID
Middle Name:DEAN
Last Name:HORN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 SUMNER AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-4602
Mailing Address - Country:US
Mailing Address - Phone:360-533-0044
Mailing Address - Fax:360-533-0549
Practice Address - Street 1:1812 SUMNER AVE STE D
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-4602
Practice Address - Country:US
Practice Address - Phone:360-533-0044
Practice Address - Fax:360-533-0549
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008352174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0208017OtherDEPT OF LABOR & INDUSTRY