Provider Demographics
NPI:1609185297
Name:HENKE, LAUREL ROSE (LMP)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:ROSE
Last Name:HENKE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7117
Mailing Address - Country:US
Mailing Address - Phone:360-670-9246
Mailing Address - Fax:
Practice Address - Street 1:1409 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7117
Practice Address - Country:US
Practice Address - Phone:360-670-9246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60177925225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA029182OtherSTATE OF WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES