Provider Demographics
NPI:1326482548
Name:HANCOCK, DANNIELLE MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:DANNIELLE
Middle Name:MARIE
Last Name:HANCOCK
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 1:8200 8TH ST SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-3627
Mailing Address - Country:US
Mailing Address - Phone:425-879-9777
Mailing Address - Fax:
Practice Address - Street 1:904 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1634
Practice Address - Country:US
Practice Address - Phone:360-474-1542
Practice Address - Fax:360-474-1247
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60041908225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist