Jackie Marie Bennett, LMP, CLT

NPI #1134412596 in Puyallup, Washington

Provider Information

NPI Number: 1134412596
Entity Type: Individual
Name: Jackie Marie Bennett, LMP, CLT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Credential: LMP, CLT
Enumeration Date: May 18, 2011
Last Updated: May 18, 2011

Practice Location

Address: 10508 123RD STREET CT E
City: Puyallup
State: Washington
ZIP Code: 98374-2626
Phone: (253) 209-6276

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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