Provider Demographics
NPI:1043470230
Name:HERBST, MELISSA JEAN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JEAN
Last Name:HERBST
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 1:2132 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-3915
Mailing Address - Country:US
Mailing Address - Phone:206-455-5194
Mailing Address - Fax:
Practice Address - Street 1:1229 CORNWALL AVE
Practice Address - Street 2:#203
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5023
Practice Address - Country:US
Practice Address - Phone:206-455-5194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60016700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist