Provider Demographics
NPI:1427102847
Name:PATTEN, JILL MARIE (LMP)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARIE
Last Name:PATTEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:615 N 161ST ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5607
Mailing Address - Country:US
Mailing Address - Phone:206-228-0918
Mailing Address - Fax:206-367-2197
Practice Address - Street 1:23700 EDMONDS WAY
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8978
Practice Address - Country:US
Practice Address - Phone:425-775-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00000616225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist