Provider Demographics
NPI:1013202522
Name:WEK, LAUREN ELAINE (CMT LMT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELAINE
Last Name:WEK
Suffix:
Gender:F
Credentials:CMT LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 W BOISE AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3502
Mailing Address - Country:US
Mailing Address - Phone:208-922-0346
Mailing Address - Fax:
Practice Address - Street 1:1080 W BOISE AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3502
Practice Address - Country:US
Practice Address - Phone:208-922-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMX110072225700000X
IDMASG-943225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist