Kennedy Jean Wesenberg, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA61512646 Issued in WA

Practice address

21707 103Rd Avenue CT E Ste B201
Graham, WA 98338-8308

Phone

(253) 847-7517

Fax

(253) 847-7467

NPI assigned

Mar 11, 2024

Last updated

Mar 11, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kennedy Jean Hansen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• McMullin Family Chiropractic, PLLC

  dba McMullin Family Chiropractic

  • Chiropractor
  • Graham, WA
  • NPI 1225894918

  Massage Therapist

  NPD

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

{
    "created_epoch": "1710115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1467210765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4529 RIDGEWEST DR E",
            "city": "LAKE TAPPS",
            "state": "WA",
            "postal_code": "983919183",
            "telephone_number": "253-691-6752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21707 103RD AVENUE CT E STE B201",
            "city": "GRAHAM",
            "state": "WA",
            "postal_code": "983388308",
            "telephone_number": "253-847-7517",
            "fax_number": "253-847-7467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WESENBERG",
        "first_name": "KENNEDY",
        "middle_name": "JEAN",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-11",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA61512646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENNEDY",
            "last_name": "HANSEN",
            "middle_name": "JEAN",
            "credential": "LMT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kaelyn Voss
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• Elisabeth Wardell, DPT
• Whitney Nichole Wason
• Kaylee D Wheeler
• Nicholas A Wilcox, D.C.
• Ariana Wilks
• Deborah S Williamson, RN
• Willow Pediatric Therapy PLLC

• Massage Therapist in Graham, WA
• Providers in Graham, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; 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.