Provider Demographics
NPI:1770851891
Name:THORESON, AMBER (LMP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:THORESON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:STANFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:8442 NE 141ST ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5326
Mailing Address - Country:US
Mailing Address - Phone:425-761-0705
Mailing Address - Fax:
Practice Address - Street 1:11911 NE 132ND ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2900
Practice Address - Country:US
Practice Address - Phone:425-814-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-03
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60255473225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist