Provider Demographics
NPI:1396522983
Name:ZOOK, JENNIFER (LMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ZOOK
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 1:3204 47TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3317
Mailing Address - Country:US
Mailing Address - Phone:206-595-2794
Mailing Address - Fax:
Practice Address - Street 1:3727 CALIFORNIA AVE SW STE 2A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4303
Practice Address - Country:US
Practice Address - Phone:206-745-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012451225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist