Provider Demographics
NPI:1376686360
Name:WOOD, LISA LYNN (LMP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:LYNN
Last Name:WOOD
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 1:1207 N 200TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3213
Mailing Address - Country:US
Mailing Address - Phone:206-533-8878
Mailing Address - Fax:206-533-8378
Practice Address - Street 1:1207 N 200TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3213
Practice Address - Country:US
Practice Address - Phone:206-533-8878
Practice Address - Fax:206-533-8378
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021115174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist