Provider Demographics
NPI:1881818979
Name:COHEN, LOEL (LMP)
Entity Type:Individual
Prefix:MS
First Name:LOEL
Middle Name:
Last Name:COHEN
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 1:9714 3RD AVE NE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115
Mailing Address - Country:US
Mailing Address - Phone:206-527-9709
Mailing Address - Fax:
Practice Address - Street 1:9714 3RD AVE NE
Practice Address - Street 2:SUITE 103
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115
Practice Address - Country:US
Practice Address - Phone:206-527-9709
Practice Address - Fax:206-526-2991
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016165174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20-1631890OtherTAX ID #