Provider Demographics
NPI:1629118427
Name:RICCIO, LOREN J (ND,LM,CPM)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:J
Last Name:RICCIO
Suffix:
Gender:F
Credentials:ND,LM,CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15650 NE 24TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2460
Mailing Address - Country:US
Mailing Address - Phone:425-505-2745
Mailing Address - Fax:425-505-2579
Practice Address - Street 1:15650 NE 24TH ST
Practice Address - Street 2:STE A
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2460
Practice Address - Country:US
Practice Address - Phone:425-202-5203
Practice Address - Fax:800-641-1831
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW293176B00000X
WANT1311175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No176B00000XOther Service ProvidersMidwife