MS. Jennifer Wallace
MS. Jennifer Wallace is an Undefined Non-Physician Type (Specify) in Everett, Washington. Qualified in 2016, 10 years ago. Practices as a sole proprietor. Licensed in Arizona and Washington.
- Years since qualifying
- 10
- Licensed in
- AZ, WA
- In the registry since
- 2020
- Specialties on file
- 13
Practice location Address checks out
3409 McDougall Ave Ste 200Everett, WA 98201-5040
Phone: (480) 685-7530
Fax: (480) 900-8853
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Specialties & licences
| Phlebotomy Technician (primary) | Taxonomy 246RP1900X |
|---|---|
| Home Health Agency | Taxonomy 251E00000X |
| Clinical Medical Laboratory | Taxonomy 291U00000X · Licence 1568068609 (AZ) |
| Phlebotomy Technician | Taxonomy 246RP1900X · Licence PC61547365 (WA) |
| Clinic/Center | Taxonomy 261Q00000X |
| Home Health Aide | Taxonomy 374U00000X · Licence EXPERIENCED (AZ) |
| Health Service Clinic/Center | Taxonomy 261QH0100X |
| Home Health Aide | Taxonomy 374U00000X (AZ) |
| Other Technician | Taxonomy 247200000X · Licence 032016 (AZ) |
| Clinical Medical Laboratory | Taxonomy 291U00000X · Licence 03D2197602 (AZ) |
| Nursing Care Agency | Taxonomy 251J00000X · Licence 03D2197602 (AZ) |
| Driver | Taxonomy 172A00000X · Licence WDL722Z7B13B (WA) |
| Technician/Technologist | Taxonomy 156F00000X |
Record details
| NPI number | 1356968440 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | Yes |
| NPI enumerated | July 6, 2020 |
| Last updated in NPPES | April 14, 2026 |
| Certification date | April 14, 2026 |
| Mailing address | 3409 McDougall Ave Ste 200, Everett, WA 98201-5040 |
Medicare enrollment
| Medicare specialty | UNDEFINED NON-PHYSICIAN TYPE (SPECIFY) |
|---|---|
| Medical school | OTHER |
| Graduated | 2016 (10 years in practice) |
| Accepts Medicare assignment | Not indicated |
| Practice locations | 2 on file with Medicare |
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