Provider Demographics
NPI:1841614286
Name:DENHAM, MELINDA (LMP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:DENHAM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18519 312TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-7901
Mailing Address - Country:US
Mailing Address - Phone:206-650-8041
Mailing Address - Fax:
Practice Address - Street 1:15715 MAIN ST NE
Practice Address - Street 2:STE. 211B
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8580
Practice Address - Country:US
Practice Address - Phone:206-650-8041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60303663225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist