Provider Demographics
NPI:1255497442
Name:DENNETT, LOIS MARIE (MA)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:MARIE
Last Name:DENNETT
Suffix:
Gender:F
Credentials:MA
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 24124
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98093-1124
Mailing Address - Country:US
Mailing Address - Phone:206-878-9098
Mailing Address - Fax:253-838-3390
Practice Address - Street 1:908 S 200TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-4101
Practice Address - Country:US
Practice Address - Phone:206-878-9098
Practice Address - Fax:253-838-3390
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist