Provider Demographics
NPI:1427392935
Name:KORYNTA, MARCY RAE (MA,EDS, NCSP)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:RAE
Last Name:KORYNTA
Suffix:
Gender:F
Credentials:MA,EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 19TH AVE
Mailing Address - Street 2:DISCOVERY PRIMARY SCHOOL
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-1223
Mailing Address - Country:US
Mailing Address - Phone:253-517-1200
Mailing Address - Fax:
Practice Address - Street 1:1205 19TH AVE
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9189
Practice Address - Country:US
Practice Address - Phone:253-517-1200
Practice Address - Fax:253-517-1205
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA450587A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist