Provider Demographics
NPI:1386799831
Name:LARGENT, JENNIFER (LMP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LARGENT
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 1:30 W MAIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2872
Mailing Address - Country:US
Mailing Address - Phone:509-520-0636
Mailing Address - Fax:
Practice Address - Street 1:30 W MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2872
Practice Address - Country:US
Practice Address - Phone:509-520-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018922174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist