Provider Demographics
NPI:1114083441
Name:MCCRONE, MALENA MARIE (LMP)
Entity Type:Individual
Prefix:MS
First Name:MALENA
Middle Name:MARIE
Last Name:MCCRONE
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 1:16222 ISSAQUAH HOBART RD SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-6964
Mailing Address - Country:US
Mailing Address - Phone:425-392-3466
Mailing Address - Fax:
Practice Address - Street 1:1595 NW GILMAN BLVD
Practice Address - Street 2:SUITE 15
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5396
Practice Address - Country:US
Practice Address - Phone:425-392-4387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012107225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist