Provider Demographics
NPI:1548795594
Name:LICE CLINICS OF AMERICA BELLEVUE
Entity Type:Organization
Organization Name:LICE CLINICS OF AMERICA BELLEVUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-719-2644
Mailing Address - Street 1:1504 184TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-3303
Mailing Address - Country:US
Mailing Address - Phone:206-719-2644
Mailing Address - Fax:
Practice Address - Street 1:1420 156TH AVE NE STE L
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4421
Practice Address - Country:US
Practice Address - Phone:206-719-2644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty