Provider Demographics
NPI:1306137609
Name:GUNNOE, JESSICA LYNN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:GUNNOE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4823
Mailing Address - Country:US
Mailing Address - Phone:360-393-5749
Mailing Address - Fax:
Practice Address - Street 1:1725 JAMES ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4823
Practice Address - Country:US
Practice Address - Phone:360-393-5749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 0018995172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker