Provider Demographics
NPI:1376882159
Name:CARLSON, HEATHER C (LMP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:C
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:HEALTHER
Other - Middle Name:C
Other - Last Name:BARTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:2000 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4218
Mailing Address - Country:US
Mailing Address - Phone:360-671-1710
Mailing Address - Fax:360-671-1605
Practice Address - Street 1:2000 N STATE ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4218
Practice Address - Country:US
Practice Address - Phone:360-671-1710
Practice Address - Fax:360-671-1605
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023837225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist