Provider Demographics
NPI:1265623243
Name:DELLON, LORETTA S (LMP)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:S
Last Name:DELLON
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 1:17034 AURORA AVE N
Mailing Address - Street 2:SUITE D
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5345
Mailing Address - Country:US
Mailing Address - Phone:206-251-6640
Mailing Address - Fax:
Practice Address - Street 1:17034 AURORA AVE N
Practice Address - Street 2:SUITE D
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5345
Practice Address - Country:US
Practice Address - Phone:206-251-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020171225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist