Provider Demographics
NPI:1750633095
Name:PHELPS, LINDA LOUISE (LAC, EAMP, DIPL AC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LOUISE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LAC, EAMP, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7324 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5401
Mailing Address - Country:US
Mailing Address - Phone:206-397-4135
Mailing Address - Fax:
Practice Address - Street 1:7324 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-5401
Practice Address - Country:US
Practice Address - Phone:206-397-4135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60161168171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist