Provider Demographics
NPI:1588807762
Name:MITCHELL, CECILY KANINAWE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:CECILY
Middle Name:KANINAWE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMP
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Mailing Address - Street 1:1815 HUDSON
Mailing Address - Street 2:STE B
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-423-3399
Mailing Address - Fax:360-423-6181
Practice Address - Street 1:1815 HUDSON
Practice Address - Street 2:STE B
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-423-3399
Practice Address - Fax:360-423-6181
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMA00017316225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0165991OtherWA STATE DEPT OF LABOR & INDUSTRIES