Provider Demographics
NPI:1285837153
Name:DEAN, DIANNA HALE (MTCM, LAC)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:HALE
Last Name:DEAN
Suffix:
Gender:F
Credentials:MTCM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 180TH ST SW APT I201
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3648
Mailing Address - Country:US
Mailing Address - Phone:206-380-2588
Mailing Address - Fax:
Practice Address - Street 1:1818 WESTLAKE AVE N STE 404
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2707
Practice Address - Country:US
Practice Address - Phone:206-380-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002259171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist