Provider Demographics
NPI:1659444370
Name:ELLE, LAUREN (LMP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ELLE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:BROWN
Other - Last Name:FLAHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:606 LILLY RD NE
Mailing Address - Street 2:APARTMENT 721
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-870-8628
Mailing Address - Fax:360-350-0723
Practice Address - Street 1:606 LILLY RD NE
Practice Address - Street 2:SUITE 102
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-870-8628
Practice Address - Fax:360-350-0723
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007940225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist