Provider Demographics
NPI:1629708672
Name:ESCUE, MICHELLE AMALIE (LMP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:AMALIE
Last Name:ESCUE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:AMALIE
Other - Last Name:BROOKS-ESCUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MICHELLE BROOKS, LMP
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-0034
Mailing Address - Country:US
Mailing Address - Phone:425-208-5048
Mailing Address - Fax:425-292-0253
Practice Address - Street 1:8103 FALLS AVE SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-5169
Practice Address - Country:US
Practice Address - Phone:425-208-5048
Practice Address - Fax:425-292-0253
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61292809225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA61292809OtherMASSAGE LISCENSE