Staci Wixom Jacobs, LMP

NPI #1831323344 in Liberty Lake, Washington

Provider Information

NPI Number: 1831323344
Entity Type: Individual
Name: Staci Wixom Jacobs, LMP
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Massage Therapist
Credential: LMP
Enumeration Date: May 12, 2009
Last Updated: May 12, 2009

Practice Location

Address: 1235 N LIBERTY LAKE RD
Address 2: SUITE 106
City: Liberty Lake
State: Washington
ZIP Code: 99019-7581
Phone: (509) 434-9959

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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