Provider Demographics
NPI:1144555822
Name:JENTSCH, LYNDSEY NICOLE (LMP)
Entity type:Individual
Prefix:MRS
First Name:LYNDSEY
Middle Name:NICOLE
Last Name:JENTSCH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:LYNDSEY
Other - Middle Name:NICOLE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:10655 NE 4TH STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2055
Mailing Address - Country:US
Mailing Address - Phone:425-455-2225
Mailing Address - Fax:425-454-7767
Practice Address - Street 1:10655 NE 4TH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2055
Practice Address - Country:US
Practice Address - Phone:425-455-2225
Practice Address - Fax:425-454-7767
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60114100225700000X
WAMA60114100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist