Jennifer Brooke Conley, PTA

Primary specialty

SpecialistTaxonomy code 174400000X

License

P160465758 Issued in WA

Practice address

25720 Maple Valley Black Diamond Rd SE
Maple Valley, WA 98038-8313

Phone

(425) 413-3400

NPI assigned

Apr 23, 2018

Sex

Female

Sole proprietor

No

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

• Tahoma School District

  • Local Education Agency (LEA)
  • Maple Valley, WA
  • NPI 1851300248
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 23, 2018.

{
    "created_epoch": "1524441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524441600000",
    "number": "1801384185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25720 MAPLE VALLEY BLACK DIAMOND RD SE",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980388313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25720 MAPLE VALLEY BLACK DIAMOND RD SE",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980388313",
            "telephone_number": "425-413-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONLEY",
        "first_name": "JENNIFER",
        "middle_name": "BROOKE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-23",
        "last_updated": "2018-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "P160465758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE DEPARTMENT OF HEALTH",
            "identifier": "P160465758",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ifeanyi Charles Chukwu, M.ED.
• Jillian Clifton, LMP
• David A Cline, MD
• Isabella Rose Colasurdo
• Briana Conley
• Michael Coombes Jr.
• Matt Copple, PHR
• Maria Costello, LSWAIC
• Cynthia Louise Cote, M.D.
• Katie Ann Cox

• All providers in Maple Valley, WA
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2018; 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.