Provider Demographics
NPI:1538336326
Name:MCGRATH, JENELLE LOU ANN (LMP)
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:LOU ANN
Last Name:MCGRATH
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 1:3619 81ST DR NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-7017
Mailing Address - Country:US
Mailing Address - Phone:425-397-6347
Mailing Address - Fax:360-659-3918
Practice Address - Street 1:1617 GROVE ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4301
Practice Address - Country:US
Practice Address - Phone:360-659-6241
Practice Address - Fax:360-659-3918
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024636225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist