Provider Demographics
NPI:1073883708
Name:SMEMO, CAITLIN (LAC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:SMEMO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5811
Mailing Address - Country:US
Mailing Address - Phone:206-228-1136
Mailing Address - Fax:
Practice Address - Street 1:1904 3RD AVE
Practice Address - Street 2:SUITE 808
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1126
Practice Address - Country:US
Practice Address - Phone:206-651-4729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60237129171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist