Provider Demographics
NPI:1518460146
Name:FLINK, KESLIE SHEA
Entity Type:Individual
Prefix:MS
First Name:KESLIE
Middle Name:SHEA
Last Name:FLINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 504
Mailing Address - Street 2:607 1ST. AVE.
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953
Mailing Address - Country:US
Mailing Address - Phone:509-829-5757
Mailing Address - Fax:509-829-5051
Practice Address - Street 1:607 1ST AVE
Practice Address - Street 2:
Practice Address - City:ZILLAH
Practice Address - State:WA
Practice Address - Zip Code:98953-9895
Practice Address - Country:US
Practice Address - Phone:509-829-5757
Practice Address - Fax:509-829-5051
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60813591225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist