Provider Demographics
NPI:1083974760
Name:BICKFORD, ANDREA L (LMP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:L
Last Name:BICKFORD
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 1:8901 W TUCANNON AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7213
Mailing Address - Country:US
Mailing Address - Phone:509-579-5999
Mailing Address - Fax:509-834-7407
Practice Address - Street 1:8901 W TUCANNON AVE STE 160
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7213
Practice Address - Country:US
Practice Address - Phone:509-579-5999
Practice Address - Fax:509-834-7407
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018713225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA17OtherMASSAGE THERAPIST