Provider Demographics
NPI:1477703379
Name:OLSEN, LEANNA L (LMP)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:L
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:LEANNA
Other - Middle Name:L
Other - Last Name:ERICKSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:8512 NE 111TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-3116
Mailing Address - Country:US
Mailing Address - Phone:360-606-6838
Mailing Address - Fax:360-216-7919
Practice Address - Street 1:410 W 8TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3113
Practice Address - Country:US
Practice Address - Phone:360-606-6838
Practice Address - Fax:360-216-7919
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020541225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist