Provider Demographics
NPI:1891874269
Name:LEE, HEIDI LYNNE (LMP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNNE
Last Name:LEE
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 1:20 LAPSLEY DR
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-9512
Mailing Address - Country:US
Mailing Address - Phone:253-370-5533
Mailing Address - Fax:
Practice Address - Street 1:20 LAPSLEY DR
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-9512
Practice Address - Country:US
Practice Address - Phone:253-370-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014297225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2022LEOtherREGENCE BLUESHIELD
WA135253OtherDEPARTMENT OF L & I