Provider Demographics
NPI:1790901866
Name:SWENSON, SARAH B (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:B
Last Name:SWENSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:SWENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8836 NE 161ST PL
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-1615
Mailing Address - Country:US
Mailing Address - Phone:425-770-5235
Mailing Address - Fax:425-483-9293
Practice Address - Street 1:18404 102ND AVE NE
Practice Address - Street 2:SUITE B
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3380
Practice Address - Country:US
Practice Address - Phone:425-770-5235
Practice Address - Fax:425-483-9293
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020588225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist