Provider Demographics
NPI:1083802243
Name:LILJEFELT, HEATHER NOEL (LMP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:NOEL
Last Name:LILJEFELT
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 1:31 228TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8601
Mailing Address - Country:US
Mailing Address - Phone:425-208-2928
Mailing Address - Fax:
Practice Address - Street 1:626 128TH ST SW
Practice Address - Street 2:STE. 103B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6368
Practice Address - Country:US
Practice Address - Phone:425-513-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00011339174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist