Provider Demographics
NPI:1295917193
Name:BRICE, CALEN DENISE (LMP)
Entity type:Individual
Prefix:MS
First Name:CALEN
Middle Name:DENISE
Last Name:BRICE
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 1:14647 NE 31ST ST
Mailing Address - Street 2:APT 7B
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3656
Mailing Address - Country:US
Mailing Address - Phone:253-882-5665
Mailing Address - Fax:
Practice Address - Street 1:14647 NE 31ST ST
Practice Address - Street 2:APT 7B
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3656
Practice Address - Country:US
Practice Address - Phone:253-882-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023328174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist