Provider Demographics
NPI:1699821231
Name:BALDERSON, LYNNE SUZANNE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:SUZANNE
Last Name:BALDERSON
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 1:14913 175TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-8037
Mailing Address - Country:US
Mailing Address - Phone:425-228-2482
Mailing Address - Fax:
Practice Address - Street 1:14410 SE PETROVITSKY RD #201
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058
Practice Address - Country:US
Practice Address - Phone:425-687-9767
Practice Address - Fax:425-227-0734
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010980225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAL&I #120067OtherL&I