Provider Demographics
NPI:1417201559
Name:ECHO, ECHO (LMP)
Entity Type:Individual
Prefix:
First Name:ECHO
Middle Name:
Last Name:ECHO
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 1:640 JADWIN AVE STE J
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4244
Mailing Address - Country:US
Mailing Address - Phone:509-946-4800
Mailing Address - Fax:509-943-1270
Practice Address - Street 1:640 JADWIN AVE STE J
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4244
Practice Address - Country:US
Practice Address - Phone:509-946-4800
Practice Address - Fax:509-943-1270
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-27
Last Update Date:2012-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60203062225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist