Provider Demographics
NPI:1568601995
Name:BLEVINS, DEANNA KAY (LMP, CR)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:KAY
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:LMP, CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2547
Mailing Address - Country:US
Mailing Address - Phone:360-609-8707
Mailing Address - Fax:
Practice Address - Street 1:2917 WASHINGTON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2258
Practice Address - Country:US
Practice Address - Phone:360-609-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023072225700000X
WACERTIFIED173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist