Provider Demographics
NPI:1497393888
Name:PARVINEN, KELSIE D (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KELSIE
Middle Name:D
Last Name:PARVINEN
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 1:8350 W. GRANDRIDGE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-737-1400
Mailing Address - Fax:509-737-1400
Practice Address - Street 1:8350 W. GRANDRIDGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-737-1400
Practice Address - Fax:509-737-1400
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61015475225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty