Provider Demographics
NPI:1427380807
Name:THOMPSON, DEENA MAYE (LMP)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:MAYE
Last Name:THOMPSON
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 1:13003 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6441
Mailing Address - Country:US
Mailing Address - Phone:425-377-3873
Mailing Address - Fax:
Practice Address - Street 1:9528 STATE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-2279
Practice Address - Country:US
Practice Address - Phone:360-658-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60117481225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist