Provider Demographics
NPI:1417297300
Name:HEDBLOOM, LYNNE M (LMT, LMP, CAMT)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:M
Last Name:HEDBLOOM
Suffix:
Gender:F
Credentials:LMT, LMP, CAMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 S EDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-5538
Mailing Address - Country:US
Mailing Address - Phone:503-440-2131
Mailing Address - Fax:
Practice Address - Street 1:620 S HOLLADAY DR
Practice Address - Street 2:SUITE #3
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-6653
Practice Address - Country:US
Practice Address - Phone:503-737-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6331225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist