Provider Demographics
NPI:1669508008
Name:MUNSON, ANDREA STEPHANIE (LMP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:STEPHANIE
Last Name:MUNSON
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:PO BOX 15782
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-0782
Mailing Address - Country:US
Mailing Address - Phone:206-528-5631
Mailing Address - Fax:
Practice Address - Street 1:9500 ROOSEVELT WAY NE
Practice Address - Street 2:SUITE 210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2252
Practice Address - Country:US
Practice Address - Phone:206-528-5631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004563225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist