Provider Demographics
NPI:1437645926
Name:SKANDALIS, LAURIE JEAN (LMP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:JEAN
Last Name:SKANDALIS
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 1:1015 NE 127TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4005
Mailing Address - Country:US
Mailing Address - Phone:206-941-3805
Mailing Address - Fax:
Practice Address - Street 1:9714 3RD AVE NE STE 103
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2047
Practice Address - Country:US
Practice Address - Phone:206-941-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-08
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004887225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist