Provider Demographics
NPI:1942635040
Name:MROCZENSKI, LISA (LMP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MROCZENSKI
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 1:1113 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-2335
Mailing Address - Country:US
Mailing Address - Phone:414-940-8886
Mailing Address - Fax:
Practice Address - Street 1:11930 SLATER AVE NE
Practice Address - Street 2:201
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4175
Practice Address - Country:US
Practice Address - Phone:425-825-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-07
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60390836225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist