Provider Demographics
NPI:1073171500
Name:SCHIPPER, ADRIANNA RAE
Entity Type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:RAE
Last Name:SCHIPPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-5016
Mailing Address - Country:US
Mailing Address - Phone:425-905-4885
Mailing Address - Fax:
Practice Address - Street 1:1040 STEVENSON AVE STE A
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2991
Practice Address - Country:US
Practice Address - Phone:360-825-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60969426225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist