Provider Demographics
NPI:1710209085
Name:HARKNESS, CAROL (LMP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:HARKNESS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:KLOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:2709 WETMORE AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3526
Mailing Address - Country:US
Mailing Address - Phone:425-285-9304
Mailing Address - Fax:425-996-9531
Practice Address - Street 1:2709 WETMORE AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3526
Practice Address - Country:US
Practice Address - Phone:425-285-9304
Practice Address - Fax:425-996-9531
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005193225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist