Provider Demographics
NPI:1285647438
Name:LEWIS, GLENDA MAE VII (LMT)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:MAE
Last Name:LEWIS
Suffix:VII
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:MAE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:3309 108TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208
Mailing Address - Country:US
Mailing Address - Phone:425-338-0910
Mailing Address - Fax:425-379-6222
Practice Address - Street 1:3309 108TH ST SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-338-0910
Practice Address - Fax:425-379-6222
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC0047444101Y00000X
WAMA00002002225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALE9077OtherREGENCE
WA8442OtherL AND I