Provider Demographics
NPI:1649560194
Name:CLARK, ALANA CHRISTINE (LMP)
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:CHRISTINE
Last Name:CLARK
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 1:969 22ND AVE
Mailing Address - Street 2:APT B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4869
Mailing Address - Country:US
Mailing Address - Phone:206-954-3582
Mailing Address - Fax:206-744-9943
Practice Address - Street 1:1801 NW MARKET ST
Practice Address - Street 2:SUITE 408
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3987
Practice Address - Country:US
Practice Address - Phone:206-784-2800
Practice Address - Fax:206-784-5257
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60208081225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist