Provider Demographics
NPI:1356422463
Name:SWANBERG CONAWAY, WENDY L (LMP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:SWANBERG CONAWAY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:L
Other - Last Name:HILL SWANBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:20708 55TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7626
Mailing Address - Country:US
Mailing Address - Phone:425-774-7440
Mailing Address - Fax:
Practice Address - Street 1:6501 196TH ST SW
Practice Address - Street 2:SUITE C
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5980
Practice Address - Country:US
Practice Address - Phone:425-775-2288
Practice Address - Fax:425-778-5476
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021475225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist