Provider Demographics
NPI:1356565931
Name:ALEXANDER, BARBARA JEAN (LMP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:JEAN
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 LAKE BELLEVUE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2480
Mailing Address - Country:US
Mailing Address - Phone:206-499-7793
Mailing Address - Fax:206-783-4522
Practice Address - Street 1:40 LAKE BELLEVUE DR STE 220
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2480
Practice Address - Country:US
Practice Address - Phone:206-499-7793
Practice Address - Fax:206-783-4522
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004665174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00004665OtherMASSAGE LICENSE