Provider Demographics
NPI:1134358112
Name:WIENEKE, ELIZABETH ANNE (LMT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:WIENEKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59113 OAK GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-2866
Mailing Address - Country:US
Mailing Address - Phone:503-396-9617
Mailing Address - Fax:
Practice Address - Street 1:161 SAINT HELENS ST STE 106
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-2029
Practice Address - Country:US
Practice Address - Phone:503-396-9617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1134358112OtherNPI TYPE 1
OR14160OtherOREGON BOARD OF MASSAGE THERAPISTS