Provider Demographics
NPI:1760917314
Name:JAHN, MARY JO
Entity type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:JAHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PACIFIC PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5463
Mailing Address - Country:US
Mailing Address - Phone:360-416-7570
Mailing Address - Fax:360-416-7580
Practice Address - Street 1:320 PACIFIC PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5463
Practice Address - Country:US
Practice Address - Phone:360-416-7570
Practice Address - Fax:360-416-7580
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28912235Z00000X
MO2016036320235Z00000X
WALL61365064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist