Provider Demographics
NPI:1154989242
Name:GUNDERSON, JANEL LORETTE (LMT)
Entity type:Individual
Prefix:
First Name:JANEL
Middle Name:LORETTE
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JANEL
Other - Middle Name:LORETTE
Other - Last Name:STYLEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:5501 NE 109TH CT STE L
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6174
Mailing Address - Country:US
Mailing Address - Phone:360-909-6476
Mailing Address - Fax:
Practice Address - Street 1:5501 NE 109TH CT STE L
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6174
Practice Address - Country:US
Practice Address - Phone:360-909-6476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60959719225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist