Provider Demographics
NPI:1902130420
Name:JOHNS, MELISSA JEPSEN (LMP, LMT, CR)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEPSEN
Last Name:JOHNS
Suffix:
Gender:F
Credentials:LMP, LMT, CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16508 NE 101ST ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-1743
Mailing Address - Country:US
Mailing Address - Phone:360-903-5863
Mailing Address - Fax:
Practice Address - Street 1:16508 NE 101ST ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-1743
Practice Address - Country:US
Practice Address - Phone:360-903-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X
WAMA60109474225700000X
OR16566225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist