Provider Demographics
NPI:1467588905
Name:KRENELKA, ILENE TERESE (LMP, LE)
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:TERESE
Last Name:KRENELKA
Suffix:
Gender:F
Credentials:LMP, LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 93RD ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-9222
Mailing Address - Country:US
Mailing Address - Phone:253-678-9692
Mailing Address - Fax:
Practice Address - Street 1:6302 93RD ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-9222
Practice Address - Country:US
Practice Address - Phone:253-678-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10948174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist