Provider Demographics
NPI:1417691734
Name:BARANOWSKI, MCKENA (LMT)
Entity Type:Individual
Prefix:
First Name:MCKENA
Middle Name:
Last Name:BARANOWSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17124 N GOLDEN DR
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-9611
Mailing Address - Country:US
Mailing Address - Phone:509-953-8334
Mailing Address - Fax:
Practice Address - Street 1:101 E HASTINGS RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-4901
Practice Address - Country:US
Practice Address - Phone:509-283-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61289829225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist