Provider Demographics
NPI:1518104231
Name:JAMES, LETICIA LYNN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:LYNN
Last Name:JAMES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:LYNN
Other - Last Name:SODORFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:4017 A ST. S.E.
Mailing Address - Street 2:B101
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002
Mailing Address - Country:US
Mailing Address - Phone:253-939-8144
Mailing Address - Fax:253-939-2289
Practice Address - Street 1:4017 A ST. S.E.
Practice Address - Street 2:B101
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002
Practice Address - Country:US
Practice Address - Phone:253-939-8144
Practice Address - Fax:253-939-2289
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025276225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist