Provider Demographics
NPI:1205908423
Name:ECKERT, GWENNA LYNN (LMP)
Entity type:Individual
Prefix:
First Name:GWENNA
Middle Name:LYNN
Last Name:ECKERT
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 1:15914 44TH AVE W APT D103
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-6158
Mailing Address - Country:US
Mailing Address - Phone:425-678-8355
Mailing Address - Fax:
Practice Address - Street 1:20833 67TH AVE W
Practice Address - Street 2:301
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7365
Practice Address - Country:US
Practice Address - Phone:425-771-5620
Practice Address - Fax:425-774-4735
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist