Provider Demographics
NPI:1336461805
Name:GUIDERO, ALYSSA DENAE CASASSA (LMP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:DENAE CASASSA
Last Name:GUIDERO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:DENAE
Other - Last Name:COLCLASURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3320 WEST MCGRAW STREET
Mailing Address - Street 2:SUITE #4
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199
Mailing Address - Country:US
Mailing Address - Phone:206-283-9910
Mailing Address - Fax:206-283-9935
Practice Address - Street 1:3320 WEST MCGRAW STREET
Practice Address - Street 2:SUITE #4
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199
Practice Address - Country:US
Practice Address - Phone:206-283-9910
Practice Address - Fax:206-283-9935
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60127915225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist