Provider Demographics
NPI:1033587878
Name:SCHENCK, KARLY (LMP)
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:
Last Name:SCHENCK
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 1:1030 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2803
Mailing Address - Country:US
Mailing Address - Phone:360-820-4850
Mailing Address - Fax:
Practice Address - Street 1:1030 NEVADA ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-2803
Practice Address - Country:US
Practice Address - Phone:360-820-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA.60511074172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker