Provider Demographics
NPI:1760670632
Name:DANIELS, LYNN E
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:E
Last Name:DANIELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-0272
Mailing Address - Country:US
Mailing Address - Phone:360-855-1207
Mailing Address - Fax:
Practice Address - Street 1:30620 PACIFIC HWY S
Practice Address - Street 2:STE #101
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4888
Practice Address - Country:US
Practice Address - Phone:253-839-1715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0775237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA214104OtherLABOR & INDUSTRIES