Provider Demographics
NPI:1902245640
Name:LEMKE, MARY JEAN (LMP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JEAN
Last Name:LEMKE
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 1:1202 S AINSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3259
Mailing Address - Country:US
Mailing Address - Phone:253-209-7900
Mailing Address - Fax:
Practice Address - Street 1:1202 S AINSWORTH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3259
Practice Address - Country:US
Practice Address - Phone:253-209-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-16
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00006501225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist