Provider Demographics
NPI:1295919652
Name:LICHTENBERG, ADELL THERESE (LMP)
Entity type:Individual
Prefix:MRS
First Name:ADELL
Middle Name:THERESE
Last Name:LICHTENBERG
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5901 ROOSEVELT WAY NE
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-525-5664
Mailing Address - Fax:206-525-6106
Practice Address - Street 1:5901 ROOSEVELT WAY NE
Practice Address - Street 2:SUITE 101A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-525-5664
Practice Address - Fax:206-525-6106
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist