Provider Demographics
NPI:1598229874
Name:LEMONS, MCKENNA (LMT)
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:LEMONS
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 1:1200 HARRIS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7142
Mailing Address - Country:US
Mailing Address - Phone:360-223-1884
Mailing Address - Fax:
Practice Address - Street 1:1200 HARRIS AVE STE 202
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7142
Practice Address - Country:US
Practice Address - Phone:360-223-1884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60811198225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist