Provider Demographics
NPI:1629562038
Name:BLACKBURN, WENDY JEANNETTE (LMT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JEANNETTE
Last Name:BLACKBURN
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 1:16440 NE 85TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3613
Mailing Address - Country:US
Mailing Address - Phone:425-885-9950
Mailing Address - Fax:425-895-9766
Practice Address - Street 1:16440 NE 85TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3613
Practice Address - Country:US
Practice Address - Phone:425-885-9950
Practice Address - Fax:425-895-9766
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60764961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist