Provider Demographics
NPI:1356500367
Name:CLEMENCE, ROXANNE (LMP, LMT)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:CLEMENCE
Suffix:
Gender:F
Credentials:LMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16408 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5951
Mailing Address - Country:US
Mailing Address - Phone:425-741-4444
Mailing Address - Fax:
Practice Address - Street 1:16408 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-5951
Practice Address - Country:US
Practice Address - Phone:425-741-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023996225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist