Provider Demographics
NPI:1346469376
Name:BAACH, JANICE SUE
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:SUE
Last Name:BAACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:S
Other - Last Name:BAACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:3702 SW 106TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-1163
Mailing Address - Country:US
Mailing Address - Phone:206-937-4140
Mailing Address - Fax:
Practice Address - Street 1:9250 45TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-2633
Practice Address - Country:US
Practice Address - Phone:206-937-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004984174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist