Provider Demographics
NPI:1679844690
Name:LINDSTROM, EMESE (MSC, LMP)
Entity Type:Individual
Prefix:
First Name:EMESE
Middle Name:
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:MSC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4932 153RD PL SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-8814
Mailing Address - Country:US
Mailing Address - Phone:425-444-2143
Mailing Address - Fax:425-338-5756
Practice Address - Street 1:4932 153RD PL SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-8814
Practice Address - Country:US
Practice Address - Phone:425-444-2143
Practice Address - Fax:425-338-5756
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60258950225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist