Jackie L. Ingram, LMP

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA00011670 Issued in WA

Practice address

3912 Martin Way E Suite B
Olympia, WA 98506

Phone

(360) 459-9780

Fax

(360) 412-0581

NPI assigned

Oct 26, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sound Massage, LLC

  • Clinic/Center
  • Olympia, WA
  • NPI 1144490806
  NPD (past)
• Susan Rosen & Associates, PLLC

  • Massage Therapist
  • Olympia, WA
  • NPI 1194860403
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1376628248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 W BULB FARM RD",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985849154",
            "telephone_number": "360-490-6490",
            "fax_number": "360-412-0581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3912 MARTIN WAY E SUITE B",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "98506",
            "telephone_number": "360-459-9780",
            "fax_number": "360-412-0581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "JACKIE",
        "middle_name": "L.",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MA00011670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "IN7892",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT. OF LABOR & IND.",
            "identifier": "125710",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Louis Infante
• Aimee Ingabire
• Quincy Ingalls
• James W Ingersoll, PH.D.
• Hayllie Ingham
• Lenore SM Ingram, DDS
• Toddy Farrell Ingram, ARNP-PMH
• Chelsea Jean Ingrim, AU.D.
• Phillip Inouye, AUD
• Inreach Therapy

• Specialist in Olympia, WA
• Providers in Olympia, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.