Provider Demographics
NPI:1588873251
Name:OLIVERES-CHANG, JONNA LEE (LMP)
Entity type:Individual
Prefix:MRS
First Name:JONNA
Middle Name:LEE
Last Name:OLIVERES-CHANG
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 1:2281 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9555
Mailing Address - Country:US
Mailing Address - Phone:360-820-0999
Mailing Address - Fax:360-922-0120
Practice Address - Street 1:301 W HOLLY ST
Practice Address - Street 2:SUITE M3
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4358
Practice Address - Country:US
Practice Address - Phone:360-820-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019952225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist