Provider Demographics
NPI:1376247627
Name:COMBS, LAKALLE OLIVIA
Entity Type:Individual
Prefix:
First Name:LAKALLE
Middle Name:OLIVIA
Last Name:COMBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2895
Mailing Address - Country:US
Mailing Address - Phone:206-552-9172
Mailing Address - Fax:
Practice Address - Street 1:12037 1ST AVE S APT B103
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168-5034
Practice Address - Country:US
Practice Address - Phone:206-771-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator