Provider Demographics
NPI:1023588530
Name:MCCOLL, CASSIE LYNN (MSA, LAC)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:LYNN
Last Name:MCCOLL
Suffix:
Gender:F
Credentials:MSA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 145TH AVE NE APT H2
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-7111
Mailing Address - Country:US
Mailing Address - Phone:206-643-7470
Mailing Address - Fax:
Practice Address - Street 1:11504 NE 21ST ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3025
Practice Address - Country:US
Practice Address - Phone:425-698-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60902039171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist