Provider Demographics
NPI:1811584725
Name:WESSON, DEEANNA (LMT, MMP, MLD-C)
Entity Type:Individual
Prefix:
First Name:DEEANNA
Middle Name:
Last Name:WESSON
Suffix:
Gender:F
Credentials:LMT, MMP, MLD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 164TH ST SW APT F203
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-9207
Mailing Address - Country:US
Mailing Address - Phone:142-537-1847
Mailing Address - Fax:
Practice Address - Street 1:4525 164TH ST SW APT F203
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-9207
Practice Address - Country:US
Practice Address - Phone:425-534-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-26
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61104444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist