Individual provider · Type 1 NPI

Theodore Basil Jerdes, LMP

Specialist · Lacey, WA

NPI number 1992251201 Active

Practice location

1210 Sleater Kinney Rd SE
Lacey, WA 98503-2316

Call (360) 352-4511 Map

Fax (360) 754-4703

Specialties and licenses

TaxonomyCodeLicense
Specialist Primary 174400000XMA 60597586 (WA)

Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

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About NPI 1992251201

Theodore Basil Jerdes, LMP's National Provider Identifier is 1992251201, issued on Aug 27, 2016. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Lacey, WA. The record was last updated on Aug 27, 2016.