Provider Demographics
NPI:1790855765
Name:VAN DEN HOF, AVIGAIL (LAC)
Entity Type:Individual
Prefix:MRS
First Name:AVIGAIL
Middle Name:
Last Name:VAN DEN HOF
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11553 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5615
Mailing Address - Country:US
Mailing Address - Phone:206-491-7746
Mailing Address - Fax:
Practice Address - Street 1:1405 NW 85TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-4237
Practice Address - Country:US
Practice Address - Phone:206-491-7746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002285171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist