Provider Demographics
NPI:1205959319
Name:BROWN, LEEANN (LMP)
Entity type:Individual
Prefix:MS
First Name:LEEANN
Middle Name:
Last Name:BROWN
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:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-0663
Mailing Address - Country:US
Mailing Address - Phone:425-348-4649
Mailing Address - Fax:425-348-0478
Practice Address - Street 1:11611 AIRPORT RD
Practice Address - Street 2:SUITE 204
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-3782
Practice Address - Country:US
Practice Address - Phone:425-348-4649
Practice Address - Fax:425-348-0478
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017848225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist