Provider Demographics
NPI:1538274121
Name:JANSEN, TERESA JANELLE (LAC)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:JANELLE
Last Name:JANSEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9805 NE 116TH ST
Mailing Address - Street 2:PMB #7249
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4245
Mailing Address - Country:US
Mailing Address - Phone:425-466-6071
Mailing Address - Fax:
Practice Address - Street 1:1429 MARKET ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5432
Practice Address - Country:US
Practice Address - Phone:425-466-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002436171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist