Provider Demographics
NPI:1508306929
Name:KEEHN, MICHEALA ROSE (LAC, EAMP)
Entity Type:Individual
Prefix:
First Name:MICHEALA
Middle Name:ROSE
Last Name:KEEHN
Suffix:
Gender:F
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7422 E GREEN LAKE DR N
Mailing Address - Street 2:APT3
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5382
Mailing Address - Country:US
Mailing Address - Phone:206-900-4884
Mailing Address - Fax:
Practice Address - Street 1:7422 E GREEN LAKE DR N
Practice Address - Street 2:APT3
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5382
Practice Address - Country:US
Practice Address - Phone:206-900-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60720497171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist