Provider Demographics
NPI:1295028900
Name:HAYES, VICKI LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:HAYES
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 1:10547 GREENWOOD AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8720
Mailing Address - Country:US
Mailing Address - Phone:206-362-4100
Mailing Address - Fax:206-362-4103
Practice Address - Street 1:10547 GREENWOOD AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8720
Practice Address - Country:US
Practice Address - Phone:206-362-4100
Practice Address - Fax:206-362-4103
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60214771225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist