Provider Demographics
NPI:1760516132
Name:BICKLE, JODY MARIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:MARIE
Last Name:BICKLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:JODY
Other - Middle Name:MARIE
Other - Last Name:LAPPIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:24121 NE 140TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077
Mailing Address - Country:US
Mailing Address - Phone:253-232-6377
Mailing Address - Fax:425-788-3340
Practice Address - Street 1:15315 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019
Practice Address - Country:US
Practice Address - Phone:425-788-0505
Practice Address - Fax:425-788-3340
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010003174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist