Provider Demographics
NPI:1336278845
Name:ECK, MISTI JEAN (LMP,CPT)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:JEAN
Last Name:ECK
Suffix:
Gender:F
Credentials:LMP,CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 N SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:MCCLEARY
Mailing Address - State:WA
Mailing Address - Zip Code:98557-9719
Mailing Address - Country:US
Mailing Address - Phone:360-259-1369
Mailing Address - Fax:
Practice Address - Street 1:95 N SUMMIT RD
Practice Address - Street 2:
Practice Address - City:MCCLEARY
Practice Address - State:WA
Practice Address - Zip Code:98557-9719
Practice Address - Country:US
Practice Address - Phone:360-259-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA22300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist