Provider Demographics
NPI:1699214858
Name:GIESECKE, LILY ELKJAER (LMP)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:ELKJAER
Last Name:GIESECKE
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 1:843 VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:WA
Mailing Address - Zip Code:98220-9705
Mailing Address - Country:US
Mailing Address - Phone:360-595-0218
Mailing Address - Fax:
Practice Address - Street 1:19 BELLWETHER WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2965
Practice Address - Country:US
Practice Address - Phone:360-647-2805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60450100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist