Provider Demographics
NPI:1003944745
Name:LYKKEN, FAITH E (LMP)
Entity Type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:E
Last Name:LYKKEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3344
Mailing Address - Country:US
Mailing Address - Phone:425-319-1211
Mailing Address - Fax:360-651-1368
Practice Address - Street 1:112 STATE AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270
Practice Address - Country:US
Practice Address - Phone:360-651-0959
Practice Address - Fax:360-651-1368
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023149174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00023149OtherMASSAGE PRACTITIONER