Provider Demographics
NPI:1558830448
Name:KRUEGER, LILITH MACGREGOR DEVEIGH (LMT)
Entity Type:Individual
Prefix:
First Name:LILITH
Middle Name:MACGREGOR DEVEIGH
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N LEWIS ST STE 111
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1516
Mailing Address - Country:US
Mailing Address - Phone:425-242-0954
Mailing Address - Fax:
Practice Address - Street 1:118 N LEWIS ST STE 111
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1516
Practice Address - Country:US
Practice Address - Phone:425-242-0954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172M00000X, 173C00000X, 374K00000X
WAMA00024428225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner