Provider Demographics
NPI:1003587155
Name:SWANSON, LAURIE ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7921 228TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8443
Mailing Address - Country:US
Mailing Address - Phone:206-799-5999
Mailing Address - Fax:
Practice Address - Street 1:1817 QUEEN ANNE AVE N STE 210
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2876
Practice Address - Country:US
Practice Address - Phone:206-799-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00013769225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist