Provider Demographics
NPI:1346406279
Name:ELLE A CLINICAL DAY SPA, INC
Entity Type:Organization
Organization Name:ELLE A CLINICAL DAY SPA, INC
Other - Org Name:ELLE A CLINICAL DAY SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-630-6768
Mailing Address - Street 1:15220 SE 272ND ST STE G
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4241
Mailing Address - Country:US
Mailing Address - Phone:253-630-6768
Mailing Address - Fax:253-630-6639
Practice Address - Street 1:15220 SE 272ND ST STE G
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-4241
Practice Address - Country:US
Practice Address - Phone:253-630-6768
Practice Address - Fax:253-630-6639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602843603174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty