Provider Demographics
NPI:1265958714
Name:BJORNDAL, HEATHER SKY (LMT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:SKY
Last Name:BJORNDAL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:SKY
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13906 SE 18TH CIR APT 9
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4711
Mailing Address - Country:US
Mailing Address - Phone:971-264-4203
Mailing Address - Fax:
Practice Address - Street 1:5424 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-4811
Practice Address - Country:US
Practice Address - Phone:503-477-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20169225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist