Provider Demographics
NPI:1821228230
Name:HONCOOP, SHAYA ELLEN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SHAYA
Middle Name:ELLEN
Last Name:HONCOOP
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SHAYA
Other - Middle Name:ELLEN
Other - Last Name:HENDRICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1800 BICKFORD AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1769
Mailing Address - Country:US
Mailing Address - Phone:425-319-1123
Mailing Address - Fax:360-863-2649
Practice Address - Street 1:1800 BICKFORD AVE
Practice Address - Street 2:STE 201
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1769
Practice Address - Country:US
Practice Address - Phone:425-319-1123
Practice Address - Fax:360-863-2649
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60055746174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist