Provider Demographics
NPI:1942571880
Name:KLIMENKO, ALENA A (LMP)
Entity Type:Individual
Prefix:MRS
First Name:ALENA
Middle Name:A
Last Name:KLIMENKO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:ALENA
Other - Middle Name:TRIFONOVA
Other - Last Name:KEMPF (CURRENT NAME)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:8303 21ST ST NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258
Mailing Address - Country:US
Mailing Address - Phone:206-478-7093
Mailing Address - Fax:425-822-2920
Practice Address - Street 1:12811 8TH- AVE W
Practice Address - Street 2:SUITE B-103
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204
Practice Address - Country:US
Practice Address - Phone:206-478-7093
Practice Address - Fax:425-822-2920
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60247270225700000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist