Provider Demographics
NPI:1306021522
Name:ENGELKE, HAYDN RUTYH (LAC)
Entity Type:Individual
Prefix:MS
First Name:HAYDN
Middle Name:RUTYH
Last Name:ENGELKE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 MLK JR WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3128
Mailing Address - Country:US
Mailing Address - Phone:206-229-5084
Mailing Address - Fax:
Practice Address - Street 1:1418 MLK JR WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3128
Practice Address - Country:US
Practice Address - Phone:206-229-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002974171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist