Provider Demographics
NPI:1528358892
Name:ELIJAH, JOY A (LMP)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:A
Last Name:ELIJAH
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 1:16915 SE 272ND ST
Mailing Address - Street 2:#100-115
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-7347
Mailing Address - Country:US
Mailing Address - Phone:425-308-0340
Mailing Address - Fax:425-277-0445
Practice Address - Street 1:15858 1ST AVE S
Practice Address - Street 2:SUITE 104
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1299
Practice Address - Country:US
Practice Address - Phone:206-838-0021
Practice Address - Fax:206-838-0021
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021276174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist