Provider Demographics
NPI:1720207541
Name:GEDDES, BONNIE JEAN
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEAN
Last Name:GEDDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12708 13TH LN SW
Mailing Address - Street 2:#D5
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-4000
Mailing Address - Country:US
Mailing Address - Phone:206-240-2039
Mailing Address - Fax:
Practice Address - Street 1:304 MAIN AVE S
Practice Address - Street 2:#201
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-2758
Practice Address - Country:US
Practice Address - Phone:206-240-2039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013959225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0159356OtherLABOR AND INDUSTRIES
WA0213404OtherLABOR AND INDUSTRIES